Stool DNA testing ‘can be performed safely’ regardless of anticoagulant, antiplatelet use
Key takeaways:
- The multitarget stool DNA test had a positive predictive value of 31.4% for detecting advanced adenomas.
- Patients on oral anticoagulants or antiplatelet agents showed no meaningful difference in detection rates.
Oral anticoagulant or antiplatelet medication use had no substantial effect on the accuracy of multitarget stool DNA testing for colorectal cancer, according to a study published in Gastro Hep Advances.
“We conducted this study to address a notable gap in the literature regarding how anticoagulants and antiplatelet agents might influence the diagnostic performance of multitarget stool DNA (mt-sDNA) testing for colorectal cancer,” Sushil Kumar Garg, MBBS, study author and assistant professor of medicine at Mayo Clinic, told Healio. “Prior investigations showed that these medications could affect the FIT, but there had been no similar exploration for mt-sDNA.”
He added, “Our project also represents one of the largest real-world assessments of mt-sDNA’s positive predictive value (PPV) to date.”
In a retrospective analysis, Garg and colleagues identified 11,761 patients with a positive mt-sDNA test result at Mayo Clinic from Jan. 1, 2018, to Oct. 12, 2023. Of those, 8,926 (75.9%) underwent follow-up colonoscopy within 1 year, and 7,750 patients aged 45 to 91 years (53.2% women) were included.
According to results, 2,435 patients were diagnosed with advanced adenoma, with the mt-sDNA test demonstrating an overall PPV of 31.4%. By agent use, the PPVs were 32.1% for non-antithrombotic users (n = 5,377), 29.2% for antiplatelet users (n = 1,650), 30.9% for anticoagulant users (n = 534) and 31.7% for antiplatelet and anticoagulant users (n = 189).
“We found that antiplatelet and anticoagulant medications did not negatively affect the PPV of mt-sDNA testing for advanced colorectal neoplasia,” Garg said. “The mt-sDNA test showed a PPV of 31.4% for detecting advanced adenomas in a large, real-world cohort — underscoring its reliability, irrespective of antithrombotic medication use.”
Regression analysis showed patients aged 65 to 79 years at mt-sDNA testing were at a lower risk for development of advanced adenoma (OR = 0.76; 95% CI, 0.62-0.94), as were those aged older than 80 years (OR = 0.7; 95% CI, 0.48-1). Former smokers (OR = 1.17; 95% CI, 1.04-1.32) and current smokers (OR = 1.56; 95% CI, 1.31-1.85) were at higher risk.
Among the 8,926 patients with a positive mt-sDNA test and follow-up colonoscopy, 116 developed CRC — a “notable” risk of 1.3%, the researchers wrote.
“These findings should reassure both clinicians and patients that mt-sDNA testing can be performed safely without stopping anticoagulant or antiplatelet therapy,” Garg told Healio. “From a practical standpoint, patients at high risk for cardiovascular or thrombotic events can continue their usual medications during CRC screening, improving convenience, safety and adherence.”
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