Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Division of Cardiology, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine and Cardiovascular Center, Yongin, Republic of Korea.
Surg Endosc. 2022 Jun;36(6):4299-4311. doi: 10.1007/s00464-021-08774-7. Epub 2021 Oct 29.
Antithrombotic agents may increase the bleeding tendency and affect the performance of fecal immunochemical test (FIT). We aimed to evaluate the impact of antithrombotic agents on the performance of FIT through a systematic review and meta-analysis.
All relevant studies published between January 1980 and September 2020 that examined the diagnostic performance of FIT were searched through MEDLINE, EMBASE, and Cochrane Library databases. We performed a meta-analysis for the positive predictive value (PPV) of FIT for detecting advanced colorectal neoplasia (ACRN) or colorectal cancer (CRC) according to the administration of antithrombotic agents including aspirin, antiplatelet agents, and oral anticoagulants (OACs).
Thirteen studies with 27,518 patients were included. Of these, 11 studies with data required for the calculation of pooled PPV were included in the meta-analysis. The pooled PPV of FIT for detecting ACRN was significantly lower in antithrombotic agent users than in non-users (odds ratio [OR] [95% confidence interval [CI]]: aspirin, 0.82 [0.68-0.99]; antiplatelet agents, 0.82 [0.69-0.96]; OACs, 0.66 [0.52-0.84]). For detecting CRC, antithrombotic agent use tended to be associated with a reduced PPV (aspirin, 0.76 [0.51-1.14]; antiplatelet agents, 0.73 [0.52-1.02]; OACs, 0.60 [0.25-1.44]). In the subgroup analysis, a FIT cutoff value of 15 μg Hb/g feces tended to be associated with lower PPVs compared to a value of 20 μg Hb/g feces in antithrombotic agent users.
Aspirin, antiplatelet agents, and OACs significantly lowered the PPV of FIT for detecting ACRN. These drugs may increase the false-positive of FIT.
抗血栓药物可能会增加出血倾向并影响粪便免疫化学检测（FIT）的性能。我们旨在通过系统评价和荟萃分析来评估抗血栓药物对 FIT 性能的影响。
通过 MEDLINE、EMBASE 和 Cochrane 图书馆数据库，检索了 1980 年 1 月至 2020 年 9 月期间发表的所有研究，这些研究检查了 FIT 的诊断性能。我们根据抗血栓药物（包括阿司匹林、抗血小板药物和口服抗凝剂）的使用情况，对 FIT 检测高级结直肠腺瘤（ACRN）或结直肠癌（CRC）的阳性预测值（PPV）进行了荟萃分析。
共纳入了 13 项研究，共 27518 名患者。其中，有 11 项研究的数据可用于计算汇总 PPV，纳入了荟萃分析。在抗血栓药物使用者中，FIT 检测 ACRN 的汇总 PPV 明显低于非使用者（比值比[OR] [95%置信区间[CI]]：阿司匹林，0.82 [0.68-0.99]；抗血小板药物，0.82 [0.69-0.96]；口服抗凝剂，0.66 [0.52-0.84]）。对于检测 CRC，抗血栓药物的使用与 PPV 降低有关（阿司匹林，0.76 [0.51-1.14]；抗血小板药物，0.73 [0.52-1.02]；口服抗凝剂，0.60 [0.25-1.44]）。在亚组分析中，在抗血栓药物使用者中，与 FIT 截止值为 20μg Hb/g 粪便相比，截止值为 15μg Hb/g 粪便时，PPV 往往较低。
阿司匹林、抗血小板药物和口服抗凝剂显著降低了 FIT 检测 ACRN 的 PPV。这些药物可能会增加 FIT 的假阳性率。
