Proceeding of The Future of Life - Legal, Scientific, and Geopolitical Challenges (TFOL2025)

<Previous Article In Volume
Next Article In Volume>

Bleeding through Legal Boundaries: Anticoagulants, Atrial Fibrillation and Intracranial Haemorrhage

A Policy and Practice Analysis

Authors
Tanaya Sarkhel1, *, Brendan Affley2
1University of Greater Manchester, Bolton, UK
2Medical Examiners Office, Ashford & St Peter’s Hospitals NHS Foundation Trust, Ashford, UK
*Corresponding author. Email: asp-tr.medicalexaminers@nhs.net
Corresponding Author
Tanaya Sarkhel
Available Online 13 March 2026.
DOI
10.2991/978-2-38476-555-3_3How to use a DOI?
Keywords
Direct oral anticoagulants (DOACs); intracranial haemorrhage; coronial referrals; Medical Examiner Service; Notification of Deaths Regulations 2019
Abstract

The expansion of Direct Oral Anticoagulant (DOAC) therapy has transformed stroke prevention in atrial fibrillation[1], but introduced new complexities in death certification. Frail patients on DOACs are increasingly represented in cases of fatal bleeding, particularly intracranial haemorrhage, triggering coronial referrals under the Notification of Deaths Regulations (2019)[2]. This practice-informed analysis explores how Medical Examiners in England and Wales can support proportionate, legally defensible decision-making at the interface of preventive medicine and coronial law. It argues for structured scrutiny, national guidance, and system-level reform to ensure that referrals reflect genuine contribution and public interest, rather than ambiguity or misinterpretation of regulatory thresholds.

Copyright
© 2026 The Author(s)
Open Access
Open Access This chapter is licensed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/), which permits any noncommercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if changes were made.

Download article (PDF)

<Previous Article In Volume
Next Article In Volume>
Volume Title
Proceeding of The Future of Life - Legal, Scientific, and Geopolitical Challenges (TFOL2025)
Series
Advances in Social Science, Education and Humanities Research
Publication Date
13 March 2026
ISBN
978-2-38476-555-3
ISSN
2352-5398
DOI
10.2991/978-2-38476-555-3_3How to use a DOI?
Copyright
© 2026 The Author(s)
Open Access
Open Access This chapter is licensed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/), which permits any noncommercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if changes were made.

Cite this article

risenwbib
TY  - CONF
AU  - Tanaya Sarkhel
AU  - Brendan Affley
PY  - 2026
DA  - 2026/03/13
TI  - Bleeding through Legal Boundaries: Anticoagulants, Atrial Fibrillation and Intracranial Haemorrhage
BT  - Proceeding of The Future of Life - Legal, Scientific, and Geopolitical Challenges (TFOL2025)
PB  - Atlantis Press
SP  - 15
EP  - 22
SN  - 2352-5398
UR  - https://doi.org/10.2991/978-2-38476-555-3_3
DO  - 10.2991/978-2-38476-555-3_3
ID  - Sarkhel2026
ER  -