University of Birmingham's Primary Care Clinical Sciences is pursuing a number of cardiovascular research projects pertaining to many aspects of anticoagulation management. It is has established a reputation as a major contributor in the field.

Research Update...


There are a few people who, after having had a clot in the legs (DVT) or lungs (PE), are at very high risk of having another one. The ExACT study aims to identify those people at highest risk of having a second clot and to see if by giving warfarin treatment for longer it is possible to prevent the second clot happening. We are looking to identify those patients at highest risk of developing post thrombotic syndrome, which is a major cause of leg ulcers. We also hope that this study will provide us with sufficient information to determine the most cost-effective means of both preventing and treating clots.

Kate Fletcher -

ExPeKT - An exploration of current knowledge and barriers to VTE prevention

Little is known about the role of primary care in thromboprophylaxis and the information high risk patients receive prior to hospital admission or after discharge. The majority of VTE episodes occur days or weeks after a patient has been discharged from hospital. Primary healthcare professionals initially responsible for patient care often remain unaware that a patient has experienced an event. Coordinated care and the integrated management of thromboprophylaxis between hospital and the community are essential. This study will explore existing knowledge and the perceived role of primary care in thromboprophylaxis. Primary health care professionals, acute trusts and other relevant organisations will be recruited to take part in the study. In addition, patients will be surveyed regarding their attitudes to receiving thromboprophylaxis and their awareness, knowledge and experience of VTE risk and assessment at each stage of their engagement with VTE prevention.

Recruitment is now completed; study results pending.

For further information please contact: Lorraine McFarland




A prospective, multi centre, international registry of male and female patients newly diagnosed with Atrial Fibrillation (AF) with at least one additional risk factor for stroke (GARFIELD-AF).

Atrial fibrillation (AF) is the most common clinically significant arrhythmia in the adult population, and a strong, independent risk factor for cerebrovascular accidents. Patients with non-valvular AF are 5 times more likely to suffer a stroke whilst patients with valvular AF see their risk increase about 17 fold. The idea of this study is to construct a large registry of patients diagnosed with AF to identify current treatment patterns and their associated outcomes, which has never been previously investigated within a non-randomised selected population. The primary target population is patients with a new diagnosis of AF with at least one additional risk factor for stroke. Patients will be enrolled in 5 sequential cohorts and followed up for a minimum of two years. GARFIELD-AF began in 2009 and enrolment to the Registry in the UK began in June 2011. Recruitment to Cohort 3 is ongoing and GARFIELD-AF is currently live in almost 150 sites across the UK. If you would like further information, please contact the study team.

Patricia Apenteng (Research Fellow) –


VTEC is a prospective cohort observational study to determine the incidence of venous thromboembolism among care home residents.  Participants will undergo a case note review of their care home notes and GP medical notes on enrolment and one year after enrolment.  Participants who die prior to the year one follow up will have end of study status and have a notes review following their death. The study is being conducted in Birmingham and Oxford and is currently in the recruitment phase. 

For further information about this study please contact:
Patricia Apenteng (Research Fellow) –


PSM Registry...

As more people undertake self- monitoring or self management of their oral anticoagulation it is important to ensure that therapeutic control is maintained. An electronic central register could provide a valuable tool for studying the safety and effectiveness of this method of service delivery. This study will evaluate the feasibility of people who self monitor or self manage entering their data onto a website to produce such a register.

This study is now closed; results pending.

Deborah McCahon -

Previous Research...

Variability in response to warfarin: a prospective analysis of pharmacogenic & environmental factors (CP450)

There is great variability in the dosage requirement of Warfarin necessary to maintain the international normalized ratio (INR) within a target range. There remains little in the way of clinical information to guide best practice with regard to starting regimes for warfarin in community-based patients. The purpose of the study is to define genetic and environmental factors that determine variability in response to warfarin. The proposed outcome of the study will be the development of a clinically useful and practical algorithm to help clinicians individualise anticoagulant therapy. The potential benefits include improved safety and cost effectiveness of warfarin therapy, improved quality of life for patients and improved uptake of warfarin therapy for atrial fibrillation (AF).

Ethnic Echocardiographic Heart of England Screeening Study

Heart failure means your heart does not pump enough blood to meet all the needs of your body. Usually, this is because the heart muscle has been damaged usually due to myocardial infarction or heart attack. As more individuals survive their heart attack, they are more prone to heart failure. This is important because it is common, costly, disabling and deadly. Further, it is also treatable.
Currently we do not know how common, i.e. the prevalence, heart failure is amongst the Black and minority ethnic groups.

Aim of the study
First study in the UK to establish the community prevalence of heart failure amongst the South Asian, Black-African and Black-Caribbean groups.

Mrs Jaskiran Dhonsi - 

Birmingham Atrial Fibrillation Treatment in the Aged Study

Atrial fibrillation (AF) is a major independent risk factor for thromboembolic disease associated with a five-fold increase in the risk of stroke. It is particularly important in the elderly... Read full text...

JWF Mant, SH Richards, FDR Hobbs, DA Fitzmaurice, GYH Lip, ET Murray, MV Banting, K Fletcher et al.
Protocol for Birmingham Atrial Fibrillation Treatment of the Aged study (BAFTA): a randomised controlled trial of warfarin versus aspirin for stroke prevention in the management of atrial fibrillation in an elderly primary care population
BMC Cardiovascular Disorders 2003, 3:9

UPDATE: This landmark study has demonstrated that warfarin is twice as effective as aspirin in protecting against stroke in patients with atrial fibrillation aged 75 and over, whilst being equally as safe in terms of haemorrhagic side-effects.

Mant J, Hobbs FDR, Fletcher K, Roalfe A, Fitzmaurice DA, Lip GYH, Murray ET.
Warfarin versus aspirin for stroke prevention in an elderly population with atrial fibrillation (the Birmingham Atrial Fibrillation treatment of the Aged Study, BAFTA): a randomized controlled trial.
Lancet 2007;370:493-503

Birmingham Anticoagulation Model

The Department of Primary Care and General Practice at the University of Birmingham has led the way in developing a model for oral anticoagulation treatment (OAT) in a primary care setting. Trials demonstrated that the use of computerised decision support systems (CDSS) and near-patient (NPT) for INR measurement offers the way into warfarin management in primary care. Read full text...

Oppenkowski T, Murray ET, Sandhur H, Fitzmaurice DA.
External quality assessment for warfarin dosing using computerised decision support software
J Clin Path 2003; 56: 605-607

Screening for Atrial Fibrillation in the Elderly

Atrial fibrillation (AF) is a major risk factor for stroke. This risk can be reduced through treatment with antithrombotic therapy, with a risk reduction of up to 68% observed with warfarin therapy. Guidelines for treatment of AF recommend ages 65 years and over as an indication for treatment with antithrombotic therapy in the presence of AF. This raises the question of whether screening for AF would be a useful policy, and if so what would be the best method for screening. Read full text...

Hobbs FDR, Fitzmaurice DA, Mant J, Murray E, Jowett S, Bryan S, Raftery J, Davies M, Lip G.
A randomised controlled trial and cost-effectiveness study of systematic screening (targeted and total population screening) versus routine practice for the detection of atrial fibrillation in people aged 65 and over. The SAFE study.
Health Technology Assessment 2005; 9(40):1-90

UPDATE: This Department of Health funded study has demonstrated unequivocally that screening for atrial fibrillation significantly increases the detection of this important condition, and perhaps surprisingly, that opportunistic screening, using pulse palpation followed by ECG, is the most cost-effective screening option.

Fitzmaurice DA, Hobbs FDR, Jowett J, Mant J, Murray ET, Holder R, Raftery JP, Bryan S, Davies M, Lip GYH, Allan TF.
Screening versus routine practice in detection of atrial fibrillation in patients aged 65 or over: cluster randomised controlled trial.
BMJ 2007;335:383, doi:10.1136/bmj.39280.660567.55 (published 2 August 2007)
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SAFE Companion paper

This SAFE companion paper has demonstrated that, whilst computerised diagnostic software performs better than primary care health professionals in diagnosing atrial fibrillation, in order to ensure a definitive diagnosis a consultant cardiologist needs to report on a 12 lead ECG.

Mant J, Fitzmaurice DA, Hobbs FDR, Jowett S, Murray ET, Holder R, Davies M, Lip GHY.
Accuracy of diagnosing atrial fibrillation on electrocardiogram by primary care practitioners and interpretative diagnostic software: analysis of data from screening for atrial fibrillation in the elderly (SAFE) trial.
BMJ 2007;335: 380, doi:10.1136/bmj.39227.551713.AE (published 29 June 2007)
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Self-management of Anticoagulation: A Randomised Trial

Objective: To determine the clinical effectiveness of self management compared with routine care in patients on long term oral anticoagulants. Read full text...

D A Fitzmaurice, E T Murray, D McCahon, J P Raftery, S Hussain, H Sandhar, F D R Hobbs
Self management of oral anticoagulation: randomised trial
BMJ 2005;331:1057