Advancing Pharmacoequity in Atrial Fibrillation—The Case for Direct Oral Anticoagulants

Ischemic stroke is one of the most devastating consequences of atrial fibrillation (AF).Oral anticoagulation for stroke risk reduction in those at moderate to high risk is a cornerstone of AF management.Direct oral anticoagulants (DOACs) were first approved in the US in 2010 and have since supplanted warfarin as the first-line oral anticoagulant for AF in most cases. 1 A major advantage of DOAC therapy, beyond its improved effectiveness and safety over warfarin, is the ease of dosing without the need for laboratory monitoring as well as fewer drug and food interactions.However, among the initial barriers to effective uptake of DOACs were the higher costs of these newer drugs.[4][5] In this issue of JAMA Network Open, Reynolds et al 6 sought to extend this literature, examining racial and ethnic differences in the initiation of DOACs vs warfarin among Medicare beneficiaries with AF and no evidence of valvular heart disease.The authors identified 950 698 episodes of oral anticoagulant initiation in this cohort from 2010 to 2019.After adjustment for individual demographic and clinical covariates, as well as county-level social vulnerability, they found that Black Open Access.