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• W2971324246 abstract "We thank Drs Yamaji and Niikura and their colleagues for their interest in our study.1Randel K.R. et al.Gastroenterology. 2019; 156: 1642-1649.e1Abstract Full Text Full Text PDF PubMed Scopus (24) Google Scholar We agree with both authors that the positive predictive value (PPV) depends on the sensitivity and specificity of the test and the prevalence of the disease. However, because we only had information of drug use among the fecal immunochemical test (FIT) positives who had a colonoscopy, and that we did not perform colonoscopy in all individuals, we could not calculate those measures. Our aim was not to investigate the causality between direct-acting anticoagulant (DOAC) use and FIT result, but to assess the diagnostic yield of FIT among subgroups of DOAC users and nonusers. Whether it is the use of DOAC itself or other contributing factors, our study cannot answer. However, on the group-level (DOAC users), our results may be of value in a screening setting where the benefits must outweigh the harm. The discrepancy between the results from Niikura et al2Niikura R. et al.Digestion. 2019; 100: 117-126Crossref PubMed Scopus (13) Google Scholar and ours is striking. As Drs Yamaji and Niikura and their colleagues point out, a possible explanation is the different adjustment for potential confounders. We explored this possibility by adding colonoscopy history, preparation quality, and cecum intubation status to our multivariable analyses, and the estimates of the association between use of anticoagulants and PPV for colorectal neoplasia remained substantially the same. We believe that the discrepancy between the results may mainly be due to real differences between the 2 cohorts, and not to different statistical methodologies. Differences were evident in both univariate and multivariable analyses. In the Japanese study population, the prevalence of colorectal cancer in DOAC users was 4.1% (9/218) and in nonusers 2.7% (132/4955; univariate odds ratio [OR], 1.57 [95% confidence interval (CI), 0.69–3.14]; multivariable OR, 1.43 [95% CI, 0.68–2.98]). In comparison, our crude PPVs were 0.9% and 5.3%, respectively (univariate OR, 0.15 [95% CI, 0.04–0.63], multivariable OR, 0.11 [95% CI, 0.03–0.49]). Some differences may exist owing to different threshold for positive FIT in the 2 studies, but the difference (20 vs 15 μg Hb/g feces) is likely too small to be a valid explanation. We fully agree with the authors that further studies are needed, especially before any drug cessation strategies can be considered. These studies should include FIT results and medical history of all participants, and all should have a colonoscopy, regardless of the FIT result. These data are most easily obtained in a referral-based colonoscopy setting or in primary screening colonoscopy. False-positive Fecal Immunochemical Tests in Users of New AnticoagulantsGastroenterologyVol. 164Issue 7PreviewWe read with great interest the article by Randel et al1 reporting lower positive predictive values (PPV) of the fecal immunochemical test (FIT) in users of direct-acting oral anticoagulants (DOACs) than in nonusers. The authors performed a large-scale cross-sectional study in an ongoing colorectal cancer (CRC) screening trial in Norway to investigate the effects of aspirin and oral anticoagulants on the performance of FIT. The use of aspirin and DOACs was associated with a significantly lower PPV for detecting CRC and advanced adenoma. Full-Text PDF RE: Effects of Oral Anticoagulants and Aspirin on Performance of Fecal Immunochemical Tests in Colorectal Cancer ScreeningGastroenterologyVol. 164Issue 7PreviewWe read with interest the recent publication by Randel et al.1 The authors concluded that regular use of aspirin, and particularly of direct-acting anticoagulants (DOACs), was associated with a lower positive predictive value (PPV) on the fecal immunochemical test (FIT) for detecting colorectal cancer and advanced adenomas.1 This finding is important, given that the effects of anticoagulants on the performance of FIT in colorectal cancer screening remain unclear. However, their results were inconsistent with our previous results,2 where no significant association was observed between DOAC use and colorectal neoplasia in a propensity score-weighted analysis. Full-Text PDF" @default.
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• W2971324246 date "2023-06-01" @default.
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• W2971324246 doi "https://doi.org/10.1053/j.gastro.2019.08.035" @default.
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