The following article is a part of conference coverage from the American Heart Association Scientific Sessions 2021, being held virtually from November 13 to 15, 2021. The team at Cardiology Advisor will be reporting on the latest news and research conducted by leading experts in cardiology. Check back for more from the AHA Scientific Sessions 2021.

Using direct oral anticoagulants (DOACs) yields similar efficacy results as using vitamin K antagonists (VKAs) in treating atrial fibrillation (AF) and venous thromboembolism (VTE) for Black patients compared with the general population, according to study results presented at AHA 2021, held from November 13 to 15, 2021.

This systematic review included 9 clinical trials (N=80,588) examining the efficacy of DOACs vs VKAs as a treatment for both AF and VTE. Pooled risk ratios (RRs) for the safety and efficacy of DOACs in treating Black patients vs the general population were estimated using the Mantel-Haenszel method. Symptomatic, recurrent VTE or stroke/systolic embolism in AF comprised the primary efficacy outcome, while major bleeding constituted the primary safety outcome.

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Among the study population, 1.67% were identified as Black patients. The efficacy of DOACs vs VKAs was similar for Black patients (RR 0.98; 95% CI, 0.62-1.55; I=0%; P =.94) and the entire population (RR 0.90; 95% CI, 0.78-1.04; I=41%; P =.1). As for safety, VKAs were associated with better safety outcomes for the entire population (RR 0.78; 95% CI, 0.65-0.93; I=76%; P <.01) compared to DOACs for Black patients (RR 0.83; 95% CI, 0.56-1.25; I=0%; P =.92).

The study authors concluded, “The use of DOACs versus VKAs in AF and VTE for [Black patients] results in similar efficacy to the general population. DOACs are noninferior to VKAs with respect to safety outcomes in AF and VTE” for Black patients. The study authors noted that further studies will be required to understand “why superiority of safety outcomes seen in the general population are not seen” among Black patients.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Klein MW, Skipina T, Schulman S, Gebel M, Budzikowski A. Efficacy and safety of direct oral anticoagulants in those identifying as Black or African-American: a systematic review and meta-analysis of randomized controlled trials. Presented at: AHA 2021; November 13-15, 2021. Poster VMP317.


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This article originally appeared on The Cardiology Advisor