SNFGE SNFGE
 
Thématique :
- Endoscopie/Imagerie
Originalité :
Intermédiaire
Solidité :
Très solide
Doit faire évoluer notre pratique :
Pas encore
 
 
Nom du veilleur :
Docteur Patrice PIENKOWSKI
Coup de coeur :
 
 
Gastroenterology
  2019/05  
 
  2019 May;156(6):1642-1649.e1.  
  doi: 10.1053/j.gastro.2019.01.040.  
 
  Effects of Oral Anticoagulants and Aspirin on Performance of Fecal Immunochemical Tests in Colorectal Cancer Screening.  
 
  Randel KR, Botteri E, Romstad KMK, Frigstad SO, Bretthauer M, Hoff G, de Lange T, Holme Ø  
  https://www.ncbi.nlm.nih.gov/pubmed/30689972  
 
 

Abstract

BACKGROUND & AIMS:

The fecal immunochemical test (FIT) is the tool most frequently used for colorectal cancer (CRC) screening worldwide. It is unclear how the use of aspirin and oral anticoagulants in the screening population affects the diagnostic performance of FIT.

METHODS:

We performed a cross-sectional study in an ongoing CRC screening trial in Norway. Participants aged 50-74 years with a positive result from an FIT (>15 μg hemoglobin/g feces) and subsequent colonoscopy (reference standard) were included. Those who used regular aspirin, warfarin, or direct-acting oral anticoagulants (DOACs) were defined as users. Non-users were matched according to age, sex, screening center, and screening round. The primary outcomes were the positive predictive value (PPV) for CRC and advanced adenoma.

RESULTS:

Among 4908 eligible participants, 1008 used aspirin, 147 used warfarin, 212 used DOACs, and 3541 were non-users. CRCs were found in 234 individuals and advanced adenomas in 1305 individuals. The PPV for CRC was 3.8% for aspirin users vs 6.4% for matched non-users (P = .006), The PPV for advanced adenoma in aspirin users was 27.2% vs 32.6% for matched non-users (P = .011). For DOAC, the PPV for CRC was 0.9% in users vs 6.8% in matched non-users (P = .001). The PPV for advanced adenoma in DOAC users was 20.5% vs 32.4% in matched non-users (P = .002). There was no significant difference in PPV for CRC or advanced adenoma in warfarin users compared to non-users.

CONCLUSIONS:

In a large screening cohort in Norway, regular use of aspirin and particularly DOACs, were associated with lower PPV of FIT for detection of CRCs and advanced adenomas. ClinicalTrials.gov ID NCT01538550.

 

 
Question posée
 
L’Aspirine et les anticoagulants sont-ils susceptibles de fausser le test immunologique ?
 
Question posée
 
Cette étude norvégienne portant sur un effectif de 4900 individus montre une diminution de la valeur prédictive positive du test chez les sujets sous aspirine ou AC tant pour le CCR que pour les Adénomes Avancés ; aucune différence n’est observée avec les AVK.
 
Commentaires

La prise d’Aspirine ou d’ACO augmente les faux positifs du test de dépistage.

 
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