RecruitingPhase IVInterventional

Preventing stroke, premature death and cognitive decline in a broader community of patients with atrial fibrillation (DaRe2THINK)

Atrial fibrillation (AF) causes an irregular and often fast heartbeat. People with AF face a higher risk of blood clots, strokes, and gradual memory decline or dementia. In the NHS, blood-thinning tablets are usually reserved for older patients or those with several other health conditions. This means younger or lower-risk patients often do not receive them. The DaRe2THINK trial is investigating whether starting modern blood-thinning tablets (called DOACs) earlier can prevent strokes, tiny hidden brain clots, and long-term memory loss. Around 3,000 patients across England will take part through their GP surgeries. Half the participants will continue their normal care, while the other half will start taking a blood thinner. The study is run remotely using NHS health records and simple online memory questionnaires, meaning participants do not need extra hospital appointments.

At a glance

Status

Recruiting

Phase

Phase IV

Sponsor

University of Birmingham

Enrolment target

3,000

Start

01 Jun 2021

Estimated completion

01 Dec 2027

Atrial fibrillation

What is this study about?

Atrial fibrillation (AF) is a common condition that affects how the heart beats. When the heart beats irregularly, blood can pool in its chambers and form small clots. If a clot travels to the brain, it can trigger a major stroke. In other cases, tiny 'micro-clots' can cause quiet damage over time, leading to memory problems and dementia. Blood-thinning medicines help stop these clots from forming.

Currently, NHS doctors usually prescribe blood thinners only to older people with AF or those who already have high-risk health problems. Younger patients—particularly those aged between 55 and 73—are often told to wait because their immediate risk of stroke is considered low. However, modern blood thinners (known as DOACs) are much safer and easier to take than older treatments like warfarin. Researchers want to find out if using these newer medicines earlier could offer vital long-term protection for the brain and heart.

DaRe2THINK is designed to fit easily around everyday life. Instead of attending frequent hospital visits, you join through your local GP surgery. Researchers track your health securely through routine NHS computer records. You simply complete short, occasional surveys on your phone, tablet, or computer to test your memory, reaction speeds, and general quality of life.

By taking part, you could help provide the clear evidence needed to update NHS guidelines. If the study proves successful, it could prevent thousands of strokes and protect brain health for future generations living with atrial fibrillation.

Key takeaways

DaRe2THINK tests whether modern blood thinners can protect younger AF patients from stroke and dementia.
The study is open to people aged 55 to 73 who have atrial fibrillation and do not currently take blood thinners.
Participation is designed to be convenient, with no extra hospital visits required.
Half of the participants will take a daily blood thinner, while the other half continue standard care.
Memory and well-being are checked remotely using quick surveys on a phone or computer.

Who may be eligible?

You may be able to join DaRe2THINK if you are aged between 55 and 73, have been diagnosed with atrial fibrillation (AF), and are registered with a participating GP surgery in England. You must not currently be taking a blood-thinning medicine.

You will not be eligible if you have already had a stroke, a mini-stroke (TIA), or a serious blood clot, or if your doctor has already recommended that you need blood thinners based on your overall health. The study also excludes anyone who has had bleeding inside the brain, a major bleed requiring hospital treatment in the last three years, or conditions that make bleeding likely, such as a recent stomach ulcer.

Finally, people with severe kidney or liver disease, those who already have a diagnosis of dementia, or those taking specific prescription antifungal treatments cannot take part. Your GP practice team will review your records to confirm whether the study is safe and suitable for you.

Could this study suit you?

Answer these quick questions to see if you may be eligible. This is a guide only — the research team makes the final call.

I am aged between 55 and 73 years old.
I have been diagnosed with atrial fibrillation (AF).
I am not currently taking regular blood-thinning tablets.
I have never had a stroke or mini-stroke (TIA).
I have not had a major bleed or stomach ulcer in the last three years.
I have not been diagnosed with dementia or severe kidney disease.

Answer every question to see your result.

What does participation involve?

If you decide to take part, you will be enrolled through your GP surgery without needing hospital visits. You will be randomly placed by a computer into one of two groups: one group continues their usual medical care without a blood thinner, and the other group starts taking a standard modern blood-thinning tablet (such as apixaban, dabigatran, edoxaban, or rivaroxaban) prescribed by their GP. The study runs over several years, during which researchers quietly monitor your health via existing NHS records. You will also be asked to complete simple, brief questionnaires on your smartphone or computer from home to check your memory, concentration, and general well-being. You can carry on with your normal daily routines throughout.

Potential risks and benefits

Taking part may give you access to a medicine that lowers your long-term chance of blood clots, strokes, and memory decline, while helping improve NHS treatment for others. However, blood thinners make it harder for the body to form clots, meaning minor bleeding (such as nosebleeds, bruising, or bleeding gums) can happen in about 1 in 10 people. Serious bleeding is rare, but if you suffer a bad fall or hit your head, you must seek urgent medical care. Joining the trial is entirely voluntary, and you can change your mind and withdraw at any time without any impact on your routine NHS treatment.

Locations (16)

Some site locations are approximate. We're improving this — please verify with the trial team before travelling.

University Hospitals Birmingham NHS Foundation Trust (and around 600 primary care practices across England)
City only
Birmingham, England
NIHR CRN: West Midlands
City only
Albrighton, England
NIHR CRN: North East and North Cumbria
City only
Newcastle-upon-Tyne, England
NIHR CRN: North West Coast
City only
Liverpool, England
NIHR CRN: Yorkshire and Humber
City only
Sheffield, England
NIHR CRN: Greater Manchester
Unverified
Manchester, England
NIHR CRN: East Midlands
Unverified
Leicester, England
NIHR CRN: West of England
Unverified
Bristol, England
John Radcliffe Hospital
Unverified
Oxford, England
NIHR CRN: Eastern
Unverified
Norwich, England
NIHR CRN: Kent, Surrey and Sussex
Unverified
Brighton, England
NIHR CRN: Wessex
Unverified
Southampton, England

Common questions

Do I have to travel to hospital appointments for this study?

No. The trial is run remotely through your GP surgery and routine NHS electronic records, alongside simple online questionnaires you can complete at home.

Can I choose whether I get the blood-thinning tablet?

No. A computer randomly decides whether you receive the blood thinner or remain on your current standard care. This ensures the results of the research are completely fair and reliable.

What is a DOAC?

DOAC stands for Direct Oral Anticoagulant. These are modern blood-thinning tablets that are widely used in the NHS, work reliably, and do not need frequent blood tests like older medicines such as warfarin.

What should I do if I cut myself or bruise while on the medicine?

Minor cuts can be managed by applying firm, continuous pressure for slightly longer than usual. If you experience heavy bleeding, a serious knock to the head, or an accident, seek urgent medical help immediately.

What happens if I decide I no longer want to take part?

You are free to leave the study at any time without giving a reason. Your standard NHS care and relationship with your doctor will not be affected in any way.

How to find out more

Alastair Mobley

a.mobley@bham.ac.uk +44 (0)7867551957 Official trial record

Always speak to your GP or specialist before deciding to take part in a study.