Clinical Practice Research Unit (CPRU)

DECISIONS is Development of a Comprehensive Intervention to Support Individuals with anticoagulation to prevent Stroke.

Stroke is now the fourth most common cause of death in the UK and the main cause of severe disability, with an estimated annual cost to the NHS of £3 billion for emergency, acute, rehabilitation, and long-term care. Conditions which put people at an increased risk of developing a blood clot, and consequently experiencing a stroke, can be successfully managed using oral anticoagulation (OAC) medicines, also known as ‘blood thinners’.

However, evidence suggests that many people who would benefit from these medications either do not receive them or do not take them in a way that would confer maximum protection. This is further complicated by the fact that for some of these conditions there are no obvious symptoms and so the underlying risk goes undetected.

For example, in England there estimated to be over 1.3 million people with atrial fibrillation (AF), of whom about 5% will go on to have a stroke each year. While one fifth of people admitted to hospital with stroke in the UK have AF, many of these people are first diagnosed with the condition only when they present with their stroke or other vascular disease.

Aims and objectives

The DECISIONS study will use co-design principles to develop a novel care pathway and a resource guide to improve uptake, shared decision making, and long-term adherence/persistence to medication in anticoagulant therapy for stroke and arterial thromboembolism prevention in AF and other conditions.

The study will take place in up to 6 GP surgeries within three Clinical Commissioning Groups (CCGs) in the North West of England and will consist of three phases designed to achieve three core objectives:

To map current service design and delivery of oral anticoagulation care for stroke and arterial thromboembolism prevention in primary care in order to critically review current models of care and their effectiveness.

Expertise and Subject area


Project Lead/Contact

Dr Josephine Gibson

Clients or Funders

National Institute for Health Research, RfPB Competition 34 Stage 2, PB-PG-0817-20043, £141,084.00


May 2019 – April 2021