Impact of antithrombotic drugs on the accuracy of fecal occult blood testing for advanced colorectal neoplasia screening: a meta-analysis and systematic review

Abstract

Background The current meta-analysis was conducted to determine whether antithrombotic drug use would affect the diagnostic accuracy of fecal occult blood testing for advanced colorectal neoplasia.

Methods Articles published between 2000 and 2019 were systematically retrieved and screened according to the inclusion and exclusion criteria by two reviewers independently. Pooled analyses were conducted with a fixed-effect model if no apparent heterogeneity (I² ≥ 50%) was found between studies; otherwise, the random effects model would be used. Sensitivity analysis and subgroup analysis were also conducted using Review Manager 5.3.

Results Pooled analysis revealed that aspirin and nonsteroidal anti-inflammatory drugs were associated with a decrease in the positive predictive value of fecal occult blood testing for advanced colorectal neoplasia screening, with a RR of 0.89 (95% CI: 0.84–0.94) and 0.88 (95% CI: 0.84–0.93, p<0.001) respectively. Subgroup analysis based on data limited to high-quality studies, fecal immunochemical testing, or in Caucasians also showed that the use of aspirin/NSAID drugs decreased the accuracy for advanced colorectal neoplasia screening.

Conclusion Aspirin/NSAIDs and direct oral anticoagulants rather than warfarin may decrease the diagnostic accuracy of fecal occult blood testing for advanced colorectal neoplasia screening.

Zusammenfassung

Hintergrund Das Hauptziel dieser Meta-Analyse war herauszufinden, ob die Anwendung antithrombotischer Medikamente die diagnostische Genauigkeit von Tests auf okkultes Blut im Stuhl bei fortgeschrittener kolorektaler Neoplasie beeinflussen würde.

Methoden 2 unabhängige Gutachter recherchierten systematisch Publikationen, die zwischen 2000 und 2019 veröffentlicht wurden, basierend auf bestimmten Ein- und Ausschlusskriterien. Gepoolte Analysen wurden unter Verwendung eines Fixed-Effects-Modells durchgeführt, in denen keine offensichtliche Heterogenität (I² ≥ 50 %) zwischen den Studien festgestellt wurde; andernfalls wurde das Random-Effects-Modell verwendet. Review Manager 5.3 wurde verwendet, um Sensitivitäts- und Subgruppenanalysen durchzuführen.

Ergebnisse Die gepoolte Analyse ergab, dass Aspirin und nichtsteroidale Antirheumatika (NSAR) mit einer Abnahme des positiven Vorhersagewerts von Tests auf okkultes Blut im Stuhl für das Screening auf kolorektale fortgeschrittene Neoplasien assoziiert waren; also mit einem RR von 0,89 (95 % KI: 0,84–0,94) und 0,88 (95 % KI: 0,84–0,93, p < 0,001). Die Subgruppenanalyse basierte auf Daten, die auf qualitativ hochwertige Studien, immunchemische Tests im Stuhl oder asiatische und europäische Populationen beschränkt waren. Die Analyse ergab, dass die Verwendung von Aspirin/NSAR-Medikamenten die Genauigkeit des Screenings auf fortgeschrittene kolorektale Neoplasie verringerte.

Schlussfolgerung Aspirin/NSAR und direkte orale Antikoagulanzien anstelle von Warfarin können die diagnostische Genauigkeit des Tests auf okkultes Blut im Stuhl beim Screening auf fortgeschrittene kolorektale Neoplasien verringern.

Schlüsselwörter

Fortgeschrittene kolorektale Neoplasie - Test auf okkultes Blut im Stuhl - Meta-Analyse - Antithrombotika

Keywords

advanced colorectal neoplasia - Fecal occult blood testing - meta-analysis - antithrombotic

Publication History

Received: 23 November 2021

Accepted after revision: 04 April 2022

Article published online:
17 May 2022

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