Effect of aspirin, warfarin, and proton-pump inhibitors on performance of fecal immunochemical test in colorectal cancer screening: a systematic review and meta-analysis

Zhongxue Han; Xueping Nan; Mingjun Ma; Ruchen Zhou; Peizhu Wang; Jing Liu; Yanqing Li; Yueyue Li

doi:10.1007/s10238-023-01196-w

Effect of aspirin, warfarin, and proton-pump inhibitors on performance of fecal immunochemical test in colorectal cancer screening: a systematic review and meta-analysis

Clin Exp Med. 2023 Dec;23(8):4355-4368. doi: 10.1007/s10238-023-01196-w. Epub 2023 Oct 7.

Authors

Zhongxue Han^#^{1

2

3}, Xueping Nan^#^{1

2

3}, Mingjun Ma^{1

2

3}, Ruchen Zhou^{1

2

3}, Peizhu Wang^{1

2

3}, Jing Liu^{1

2

3}, Yanqing Li^{1

2

3}, Yueyue Li^{4

5

6}

Affiliations

¹ Department of Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 107 Wenhuaxi Road, Jinan, 250012, Shandong Province, China.
² Laboratory of Translational Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.
³ Robot Engineering Laboratory for Precise Diagnosis and Therapy of GI Tumor, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.
⁴ Department of Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 107 Wenhuaxi Road, Jinan, 250012, Shandong Province, China. lyynqj@126.com.
⁵ Laboratory of Translational Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China. lyynqj@126.com.
⁶ Robot Engineering Laboratory for Precise Diagnosis and Therapy of GI Tumor, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China. lyynqj@126.com.

^# Contributed equally.

PMID: 37804359
DOI: 10.1007/s10238-023-01196-w

Abstract

This study aims to investigate the impact of antithrombotic agents and proton-pump inhibitors (PPIs) on fecal immunochemical test (FIT). PubMed, EMBASE, Web of Science, Cochrane Central, and Google Scholar were searched from inception until September 3, 2023. Studies comparing the diagnostic performance of FIT between medicine users and non-users in average-risk colorectal cancer screening populations were included. Pooled sensitivity, specificity, and positive predictive values (PPVs) for advanced neoplasia (AN) of FIT were compared by reporting pooled odds ratios (ORs) with 95% confidence intervals (CIs) using a random-effects model. Twenty-two studies enrolling 5,572,367 individuals were included. For aspirin, pooled sensitivity and specificity for AN were 57.2% and 88.4% in users versus 60.2% and 93.2% in non-users; while pooled ORs were 1.49 (95% CI 0.89-2.48, P = 0.13) and 0.72 (95% CI 0.62-0.83, P < 0.001), respectively. In subgroup analysis, there was no difference in sensitivity and specificity between the two groups at the cutoff of 20 μg Hb/g (P = 0.57 and 0.29, respectively) but a significantly lower specificity in users compared with non-users at lower cutoffs (P < 0.001). Moreover, a significantly lower PPV_AN in users compared with non-users was observed after matching age and sex confounders (P = 0.001). Warfarin had no significant influence on PPV_AN of FIT (P = 0.43). PPIs were associated with a significantly lower PPV_AN in users (P < 0.001). Aspirin use was associated with lower specificity and PPV of FIT. Aspirin discontinuation before FIT to reduce false-positive results should be interpreted with caution given concerns about cardiovascular events. Increasing cutoff values of FIT in aspirin users may be another possible approach. Additionally, warfarin withdrawal before FIT is unnecessary but PPIs withdrawal before FIT is recommended to reduce false-positive results.

Keywords: Aspirin; Colorectal cancer; Fecal immunochemical test; Proton-pump inhibitors; Warfarin.

Publication types

Meta-Analysis
Systematic Review
Review

MeSH terms

Aspirin*
Colonoscopy
Colorectal Neoplasms* / diagnosis
Early Detection of Cancer / methods
Humans
Proton Pump Inhibitors
Warfarin

Substances

Aspirin
Warfarin
Proton Pump Inhibitors