Aspirin does not prevent recurrence of colorrectal adenomas in patients with coronary artery disease

Abstract

Background: Aspirin has been reported to prevent colorectal adenoma recurrence. In contrast, we observed a high prevalence of colorectal adenomas in patients with coronary artery disease (CAD) in our previous study. Aims: To investigate whether aspirin prevents colorectal adenomas recurrence in patients with CAD. Methods: Patients scheduled for coronary angiography as workup for CAD were enrolled for screening colonoscopy as described in our previous study. Patients with colorectal adenoma after a clearance colonoscopy were recruited for follow up study. Surveillance colonoscopy was performed at the end of first year. Aspirin was prescribed to patients with CAD (aspirin group) as part of the routine management, but not to those without (control group). Results: There were 46 patients with coronary artery disease (aspirin group) and 51 without (control). There was no difference in sex (91.3% male vs 82.4%, p=0.19), age (66 ± 7 vs 64 ± 8 yrs, p=0.18) or advanced colorectal lesion (23.9% vs 17.6%, p=0.44) at screening colonoscopy in the two groups. In the surveillance colonoscopy, the aspirin group, did not have a lower colorectal adenoma recurrence rate (32.6% vs 27.5%, p=0.58) nor advanced lesion (15.2% vs 7.8%, p=0.25) than the control. However, the presence of advanced lesion in the first screening colonoscopy predicted the subsequent recurrence of colorectal adenoma (50% vs 24.7%, p=0.028). Conclusion: Aspirin does not reduce colorectal adenoma recurrence rate at 1-year in those with CAD. This may be secondary to the multiple concomitant risk factors.