Effects of Oral Anticoagulant and Antiplatelet Agents on Performance of Multitarget Colorectal Cancer Screening Test

The multitarget stool DNA (mt-sDNA) test is a noninvasive screening tool for colorectal cancer. We aimed to clarify the effects of antiplatelet and anticoagulant medications on the diagnostic performance of this test.

We retrospectively identified patients undergoing mt-sDNA testing from Mayo Clinic sites across the US during a 5-year period. Participants with positive stool testing results and subsequent high-quality colonoscopy were included. Participants were grouped by medication use: antiplatelets, anticoagulants, both, or none of these medications. The primary outcomes were the effects on positive predictive value (PPV) of the test for identifying advanced adenoma by antithrombotic use.

Of the 11,761 persons with a positive mt-sDNA test result, 8926 persons (age range, 45-91 years) underwent colonoscopy at our institution, of which 7750 were deemed high quality. Among these, 2435 patients were diagnosed with advanced adenomas, for a PPV of 31.4% for detecting advanced adenomas with the mt-sDNA test. The PPVs for advanced adenoma were 32.1% in nonantithrombotic users, 29.2% in antiplatelet users, 30.9% in anticoagulant users, and 31.7% in users of both medications. Additionally, among all patients with positive mt-sDNA testing and subsequent follow-up colonoscopy (n = 8926), colorectal cancer developed in 116 patients, for a notable 1.3% risk of cancer after positive test results and colonoscopy.

In a large retrospective cohort in the US, the PPV of mt-sDNA testing for advanced adenomas was 31.4%. Use of antiplatelet or anticoagulant agents did not affect the PPV for detection of advanced adenomas.