Testa S, et al. - Considering the lack of an established management strategy for major bleeding in patients treated with direct oral anticoagulants (DOACs), START-Events [a branch of the START registry (Survey on anTicoagulated pAtients RegisTer)] sought at describing the actual management of bleeding or recurrent thrombotic events. Researchers here described the results of the management of major bleeding events in 117 patients treated with DOACs. Therapeutic strategies with/without surgery or invasive procedures were: fluid replacement or red blood cells transfusion, prothrombin complex concentrates (3 or 4 factors), antifibrinolytic drugs, and the administration of idarucizumab. Mortality during hospitalization and at 6-month follow-up was 11.9% and 15.5%, respectively. Data thereby confirm that the management of bleeding complications in patients treated with DOACs is highly heterogeneous.