Below are links to useful anticoagulation management resources, in the form of authoritative guidelines, recent papers, books and links to third party websites. We endeavour to keep the information on this page as up-to-date as possible, so keep calling back to remain informed.


Oral anticoagulation management and stroke prevention: The primary care perspective (4th Edition)


"The fourth edition of our book, continues to prove popular with students on the oral anticoagulation courses we run at the National Centre for Anticoagulation Training (NCAT) in Birmingham.

The major update in this edition is the section on new oral anticoagulants. We have now entered a new era for stroke prevention in atrial fibrillation and it will be interesting to view the impact of these new agents over the coming years. Warfarin and the vitamin K antagonists will be with us for some years to come, but their use will undoubtedly wane. Some thought will need to be given to service redesign, but the anticoagulation clinic is likely to be with us into the next decade.

As always, I would like to thank all the contributors and also our readers for providing valuable feedback. I hope this edition proves as successful and useful as the previous three."

Professor David Fitzmaurice

Written in an easy-to-follow format, with specific learning outcomes and concise summaries for each chapter, this book is essential reading for any practice interested in developing its expertise in these two areas.

"The content is of high standard, very relevant, and although I have been an anticoagulant nurse for 2 years, I still found the book to be relevant to my education."

Ruth Ogilvie, CLOT Newsletter, Summer 2002, p 2

The book costs £18.95 per copy + £3 p&p, to order a copy, please send a cheque made payable to 'University of Birmingham' and forward to:

Amy Partleton
Room 101, Institute of Occupational and Environmental Medicine (IOEM)
School of Health and Population Sciences
University of Birmingham
B15 2TT

Please include your contact details on the back of the cheque.

Selected papers...

McFarland L, Murray E, Harrison S, Heneghan C, Ward A, Fitzmaurice D, Greenfield S "Current practice of venous thromboembolism prevention in acute trusts: a qualitative study" BMJ Open 4:e005074 doi:10.1136/bmjopen-2014-005074

Jones C, Pollit V, Fitzmaurice D, Campbell C "The management of atrial fibrillation: summary of updated NICE guidance" BMJ 2014;348:g3655

Apenteng NP, Murray ET, Holder R, Hobbs FDR, Fitzmaurice DA "An international longitudinal registry of patients with atrial fibrillation at risk of stroke (GARFIELD): the UK protocol" BMC Cardiovascular Disorders 2013, 13:31. DOI: 10.1186/1471-2261-13-31 URL:

Tullett J, Murray E, Nichols L, Holder R, Lester W, Rose P, Hobbs FDR, Fitzmaurice  DA "Trial Protocol: A randomised controlled trial of extended anticoagulation treatment versus routine anticoagulation treatment for the prevention of recurrent VTE and post thrombotic syndrome in patients being treated for a first episode of unprovoked VTE (The ExACT Study)" BMC Cardiovascular Disorders 2013, 13:16. DOI: 10.1186/1471-2261-13-16

Kitchen DP, Kitchen S, Jennings I, Woods T, Fitzmaurice DA, Murray E, Walker I . "Point of Care INR testing devices: performance of the Roche CoaguChek XS and XS Plus in the UK NEQAS BC external quality assessment programme for healthcare professionals: four years’ experience". J Clin Pathol doi:10.1136/jclinpath-2012-201049

McCahon D, Murray ET, Murray K et al. "Does self-management of oral anticoagulation therapy improve quality of life and anxiety?" Family Practice 2011 Volume: 28 Issue: 2 Pages: 134-140

Fitzmaurice DA, Murray ET, Hobbs FDR. "ExACT: Extended anticoagulation treatment for VTE: a randomised trial". Journal of Thrombosis and Thrombolysis Volume: 31 Issue: 3 Special Issue: SI  Pages: 399-399

Fitzmaurice DA, Rose PE, Murray ET. "Are new oral anticoagulants set to transfer provision of anticoagulation to primary care?" Primary Care Cardiovascular Journal 2009; 2:34-37.

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

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: 380-383, doi:10.1136/bmj.39227.551713.AE (published 29 June 2007)

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)

McCahon D, Murray ET, Jowett S, Sandhar HS, Holder, RL   Hussain, S, O'Donoghue B, Fitzmaurice DA. "Patient self management of oral anticoagulation in routine care in the UK." J Clin Pathol 2007;60:1263-1267 

“External quality assessment (EQA) should be an inherent component of patient self-management (PSM) of oral anticoagulation.”

A recent study: Quality assurance for oral anticoagulation self management QAASM: a cluster randomised trial, has yielded results indicating patients are able to undertake a formal EQA scheme and perform more reliably at home independently. The paper is an online accepted article of the British Journal of Thrombosis and Haematosis, click here to read more...

"Patient self-monitoring is as effective as good quality specialised anticoagulation clinics in maintaining the quality of anticoagulation therapy." Health Technology Assessment 2007; Vol 11: number 38

The National Institute for Health Research Health Technology Assessment Programme (HTA) produces independent research about the effectiveness of different healthcare treatments and tests for those who use, manage and provide care in the NHS. A systematic review and economic modelling of the clinical effectiveness and cost-effectiveness of different models of managing long-term oral anticoagulation therapy was recently published, it concludes 'For selected and successfully trained patients, self-monitoring is effective and safe for long term oral anticoagulation therapy.'

Read / download full text (PDF)

More information on cardiovascular research at the University of Birmingham.

Details of other research conducted by the University of Birmingham's Department of Primary Care and General Practice can be found here.

Reference materials...

National Institute for Health and Care Excellence Atrial Fibrillation CKS

Pink J, Lane S, Pirmohamed M, Hughes DA "Dibigatran etexilate versus warfarin in management of non-valvular atrial fibrillation in UK context: quantitative benefit-harm and economic analyses" BMJ 2011; 343:d6333, doi 10.1136/bmj.d6333

Granger CB, Alexander JH, McMurray JJV et al "Apixaban versus warfarin in patients with atrial fibrillation" The New England Journal of Medicine 2011; 365, 11; 981 – 992

Patel MR, Mahaffey KW, Garg J et al "Rivaroxaban versus warfarin in nonvalvular atrial fibrillation" The New England Journal of Medicine 2011; 365, 10; 883 – 891

Keeling D, Baglin T, Tait C et al. ‘Guidelines on oral anticoagulation with warfarin - Fourth Edition’. Blackwell Publishing Ltd, British Journal of Haematology 2011. doi:10.1111/j.1365-2141.2011.08753.

Connolly SJ, Eikelboom J, Joyner C et al "Apixaban in patients with atrial fibrillation" The New England Journal of Medicine 2011; 364, 9; 806 – 817

ESC guidelines for the management of Atrial Fibrillation ESC guidelines update taskforce. European Heart Journal 2010; 31: 2369 – 429.

Connolly SJ, Ezekowitz MD, Yusuf S et al "Dabigatran versus warfarin in patients with atrial fibrillation" The New England Journal of Medicine 2009; 361, 12; 1139 - 1151

National Institute for Health and Care Excellence. Atrial Fibrillation: The management of atrial fibrillation. CG36. 2006.

Baglin TP, Keeling DM, Watson HG for the British Committee for Standards in Haematology "Guidelines on oral anticoagulation (warfarin) ~ Third edition 2005 update"
2005 British Society for Haematology, 132, 277–285

Near Patient Testing Working Party, Members of the General Haematology Task Force of BCSH, Members of the Thrombosis and Haemostasis Task Force of the BCSH
Guidelines for Near Patient Testing (NPT) ~ Haematology Clin Lab Haem 1995 17.301-310

Hirsh J, Poller L "The international normalized ratio. A guide to understanding and correcting its problems" Arch Intern Med. 1994;154:282-288.

Fitzmaurice DA, Machin SJ on behalf of the British Society of Haematology Task Force for Haemostasis and Thrombosis "Recommendations for patients undertaking self-management of oral anticoagulation" BMJ 2001;323:985–9

Murray ET, Kitchen DP, Kitchen S, Jennings I, Woods TAL, Preston FE, Fitzmaurice DA. "Patient self-management of oral anticoagulation & external quality assessment procedures" British Journal of Haematology, 2003, 122, 825–828

Poller L, Shiach CR, MacCallum PK, Johansen AM, Munster AM, Magalhães A, Jespersen J, on behalf of the European Concerted Action on Anticoagulation "Multicentre randomised study of computerised anticoagulant dosage" Lancet 1998; 352: 1505–09

David Parry, David Fitzmaurice and James Raftery
Anticoagulation management in primary care: a trial-based econimic evaluation
British Journal of Haematology, 2000, 111, 530-533

No Authors Listed
Risk factors for stroke efficacy of antithrombotic therapy in atrial fibrillation
Arch Intern med 1994; 154:1449-1457

Department of Health National Service Framework – for older People

Modern standards & service models, Standard 5: Stroke

Fitzmaurice DA, Kesteven P, Gee KM, Murray ET and McManus R "A systematic review of outcome measures reported for the effectiveness of oral anticoagulationJ. Clin. Pathol. 2003;56;48-51

Gualtiero Palareti, Nicoletta Leali, Sergio Coccheri, Mario Poggi, Cesare Manotti, Armando D’Angelo, Vittorio Pengo, Nicoletta Erba, Marco Moia, Nicola Ciavarella, Gianluigi Devoto, Mauro Berrettini, Serena Musolesi, on behalf of the Italian Study on Complications of Oral Anticoagulant Therapy
Bleeding complications of oral anticoagulant treatment: An inception-cohort, prospective collaborative study
Lancet 1996; 348: 423–28

Hobbs FDR, Fitzmaurice DA, Murray ET, Holder R, Rose PE and Roper JL "Is the international normalized ratio (INR) reliable?" J. Clin. Pathol. 1999;52;494-497

Munir Pirmohamed, Sally James, Shaun Meakin, Chris Green, Andrew K Scott, Thomas J Walley, Keith Farrar, B Kevin Park and Alasdair M Breckenridge
Adverse drug reactions as cause of admission to hospital: prospective analysis of 18,820 patients
BMJ 2004;329;15-19

External Links...


UK NEQAS for Blood Coagulation
Link to the national EQA programme provider for tests of Blood Coagulation, including details of forthcoming meetings:
Please click here for the link to Meetings / Blood Coagulation Diary webpage

We are currently reviewing our list of external links, in the mean time If you know of a website you think should be added, please email the details...

Lifeblood: The Thrombosis Charity wishes to increase awareness of thrombosis among the public and health professionals and to raise research funds to improve patient care through improved prevention and treatment of venous thromboembolic disease.

Their website is packed with useful information and educational material for both health care professionals and the general public