A study of barriers and enablers in the introduction of direct and oral anticoagulants (DOACs) for atrial fibrillation into patient care

Kristina Medlinskiene, University of Bradford

This summary of the project has been co-written with the PPI Advisory group. 


Atrial fibrillation (or AF) is the most common heart rhythm disturbance seen by doctors. AF greatly increases a person’s risk of stroke. AF-related strokes can be prevented with blood-thinning medicines. Warfarin, a traditional blood-thinning medicine, has been used for many years. In the past five years, we have seen new blood-thinning medicines called direct oral anticoagulants (DOACs) being used. There are particular reasons why DOACs, such as apixaban, dabigatran, edoxaban and rivaroxaban, may be preferred over warfarin. They do not require frequent monitoring or change in dosing, and they have fewer interactions with food or other medicines. Despite advantages of DOACs, their national up take has been slow and much lower in the United Kingdom (UK) compared to other European countries. Also, some areas in the UK use a lot of DOACs and some areas very little. This suggests that patients with AF may be offered different blood-thinning therapy options depending on where they live. 


I aim to understand: 

  • Why the use of DOACs is different between Bradford, Leeds and Sheffield areas; 
  • What helps or stops the use of new medicines like DOACs in Bradford, Leeds, and Sheffield areas. 


The study has three phases: 

  • FIRST PHASE: I will review published evidence on this topic to summarise what is already known. 
  • SECOND PHASE: I will find out how new medicines are implemented in local organisations (hospitals and general practices). I will do this by: 
  • Observing meetings where decisions about local use of new medicines are made; 
  • Examining locally produced documents for the use of DOACs. 

I will also talk with patients with AF who take blood-thinning medicines to learn about their experiences.  

  • THIRD PHASE: I will talk with healthcare professionals, people involved in making DOACs available locally, and people from pharmaceutical companies supplying DOACs to understand their views on what helps or stops the use of DOACs locally. 


I will produce recommendations on how to improve availability of medicines like DOACs in local NHS organisations so that more patients have access to and can benefit from them. 

Reporting of findings 

I will write a report summarising the study findings and publish in academic journals. I will also share study finding with patients, prescribers, policy makers, and academics at local events and national conferences.  

Patient and Public Involvement (PPI) 

formed PPI Advisory group will support the study. They will advise on planning, delivery, evaluation of the study and communication of the study results to the public.  

This project is running from 01/10/2019 and is due to finish on 30/06/2021