Testing blood thinners to prevent stroke in people with atrial fibrillation

Trial details

Who runs it

University of Birmingham

Trial code

NCT04700826

Record updated

16 May 2025

Original description

The DaRe2 approach (healthcare Data for pragmatic clinical Research in the NHS - primary 2 secondary) is designed to operationalise efficient, nationwide, primary care approaches for randomised trials embedded within the UK National Health Service (NHS), providing automated screening, targeted patient enrolment and 'no-visit' follow-up through innovations in big data and technology solutions.Read full original descriptionShow less

Preventing Stroke, Premature Death and Cognitive Decline in a Broader Community of Patients With Atrial Fibrillation Using Healthcare Data for Pragmatic Research: A Randomised Controlled Trial

The DaRe2 approach (healthcare Data for pragmatic clinical Research in the NHS - primary 2 secondary) is designed to operationalise efficient, nationwide, primary care approaches for randomised trials embedded within the UK National Health Service (NHS), providing automated screening, targeted patient enrolment and 'no-visit' follow-up through innovations in big data and technology solutions.

DaRe2THINK will be the first exemplar of this system, and is appropriately focused on the intersection of key national priorities for healthcare; atrial fibrillation (a heart rhythm condition that will double in prevalence in the next few decades) and the impact this condition has on stroke, thromboembolic events, cognitive impairment and vascular dementia. The trial will test the hypothesis that direct oral anticoagulants (DOACs), now commonly used in older patients with atrial fibrillation (AF), are effective and cost-effective at reducing major adverse clinical events in younger patients at low or intermediate risk of stroke, and can reduce the high rate of cognitive decline. The health technology innovations noted above will allow the investigators to answer this important clinical question, as well as demonstrate the capacity and potential of this system for future, large-scale healthcare-embedded clinical trials for patient benefit.

Inclusion: Diagnosis of AF (previous, current or chronic); Age at enrolment ≥55 years to ≤73 years.

Exclusion: Prior documented stroke, transient ischaemic attack or systemic thromboembolism; Combination of multiple known risk factors for stroke where oral anticoagulation would ordinarily be started, including: Heart failure; Hypertension; Age 65 years or older; Diabetes mellitus; Previous myocardial infarction, peripheral artery disease or aortic plaque; and/or Female gender; Any prior history of intracranial bleeding; Prior major bleeding requiring hospitalisation in the last 3 years; Patients receiving systemic treatment with azole-antimycotics within the last 3 months (ketoconazole, itraconazole, voriconazole and posaconazole); Currently receiving an anticoagulant; Condition that poses a significant risk for bleeding (within 12 months) including gastrointestinal ulceration, brain/spinal/ophthalmic injury or surgery, arteriovenous malformations or vascular aneurysms, major intraspinal or intracerebral vascular abnormalities, hepatic disease associated with coagulopathy, known or suspected oesophageal varices, and cancers with high bleeding risk; Documented diagnosis of dementia; Hypersensitivity or known intolerance to direct oral anticoagulants; Active clinically-significant bleeding; Life expectancy estimated <2 years; Estimated glomerular filtration rate <30 mL/min/1.73m2 measured within the last 12 months; Any clinical indication for anticoagulation; Participant unable or unwilling to provide informed consent for access and linkage of past and future electronic healthcare records; Currently participating in another clinical trial; Women of childbearing potential.

ClinicalTrials.gov NCT04700826