Regular use of aspirin, and particularly direct-acting oral anticoagulants (DOACs), were not associated with lower positive predictive value (PPV) of fecal immunochemical test (FIT) for detection of colorectal cancers (CRCs) and advanced adenomas in a large screening cohort. Researchers performed a cross-sectional study in an ongoing CRC screening trial with participants aged 50‒74 years with a positive result from a FIT and subsequent colonoscopy. Those who used regular aspirin, warfarin, or DOACs were defined as users. The primary outcomes were the PPV for CRC and advanced adenoma. Among the findings:

• Among 4,908 eligible participants, 1,008 used aspirin, 147 used warfarin, 212 used DOACs, and 3,541 were nonusers.
• CRCs were found in 234 individuals and advanced adenomas in 1,305 individuals.
• The PPV for CRC was 3.8% for aspirin users vs 6.4% for matched nonusers; the PPV for advanced adenoma in aspirin users was 27.2% vs 32.6% for matched nonusers.
• For DOAC the PPV for CRV was 0.9% in users vs 6.8% in matched nonusers ; the PPV for advanced adenoma in DOAC users was 20.5% vs 32.4% in matched nonusers.