Propensity Score-matched Analysis of the Impact of Direct-acting Oral Anticoagulants on Fecal Immunochemical Test Performance

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Objectives: The fecal immunochemical test (FIT) is widely used for colorectal cancer (CRC) screening, owing to its high diagnostic accuracy. Antithrombotic medications, particularly direct-acting oral anticoagulants (DOACs), can influence FIT performance; however, the evidence concerning this phenomenon remains inconsistent in the literature. This study evaluated the impact of DOACs on the positive predictive value (PPV) of FIT for diagnosing advanced neoplasia (AN). Methods: This retrospective study, conducted at Mie University Hospital, analyzed 818 patients who underwent colonoscopy procedures following positive FIT results between 2015 and 2024. A propensity score-matched analysis was used to compare PPVs for AN, advanced adenoma, invasive cancer, and all adenomas in the patients who did and did not use DOAC. A logistic regression model was used to conduct a sensitivity analysis evaluating the associations between DOAC use and FIT performance. Results: = 0.024). Conclusions: DOAC use significantly reduced the PPV of FIT for diagnosing AN. This finding suggests that current guidelines should consider alternative strategies, such as adjunctive diagnostic tools, to improve accuracy and reduce unnecessary colonoscopies in patients using DOACs.

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