From the Guidelines
You do not need to stop taking acetaminophen or NSAIDs like ibuprofen and aspirin before undergoing a Fecal Immunochemical Test (FIT). According to a high-quality study published in Gastroenterology in 2017 1, FIT testing is not confounded by the intake of certain medications, including aspirin and nonsteroidal anti-inflammatory drugs. The study found that these medications do not negatively impact the test characteristics of FIT, and in some cases, may even improve sensitivity with little decrease in specificity.
The key advantages of FIT over older guaiac-based fecal occult blood tests (gFOBT) include:
- Not being affected by dietary intake of foods with peroxidase activity
- Not being confounded by the intake of certain medications, such as aspirin and NSAIDs
- Specifically detecting human hemoglobin from the lower digestive tract, reducing false positive results
Some important points to consider:
- The study found no evidence of diminished test performance in users of aspirin or anticoagulants compared to nonusers of these medications 1
- The FIT test's specificity for human hemoglobin means it won't react to bleeding in the upper digestive tract or to blood from consumed food
- It's always best to inform your healthcare provider about your medication schedule and any specific health conditions before the test, but stopping acetaminophen and NSAIDs is not necessary for the FIT test.
From the Research
Stopping Acetaminophen and NSAIDs Before FIT
- There is no evidence to suggest that stopping acetaminophen before a Fecal Immunochemical Test (FIT) is necessary 2, 3.
- Studies have shown that the use of non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin does not significantly affect the risk of postpolypectomy bleeding during colonoscopy 4, 5.
- A systematic review and meta-analysis found that the use of oral anticoagulants (OACs) and NSAIDs does not affect the accuracy of FIT results in colorectal cancer screening 6.
- The study concluded that withdrawal of OACs or NSAIDs before FIT screening is not recommended 6.
- It is essential to note that acetaminophen and NSAIDs have different mechanisms of action and effects on the body, and their use should be considered separately in the context of FIT screening.
Clinical Considerations
- The decision to stop or continue acetaminophen and NSAIDs before a FIT should be based on individual patient factors and clinical judgment.
- Patients should consult their healthcare provider for personalized advice on medication management before undergoing a FIT.
- The use of acetaminophen and NSAIDs should be carefully considered in patients with a history of bleeding or other medical conditions that may affect the risk of bleeding or interact with these medications.