Non-major bleedings in patients with atrial fibrillation treated with direct oral anticoagulants (DOACs): Cardiologists practical management approaches: The HEMICARD survey

Objective This French survey was conducted to explore cardiologists’ practices in managing non-major bleedings (NMBs) in patients with nonvalvular atrial fibrillation (NVAF) treated by direct oral anticoagulant. The primary objective was to describe the management of patients receiving DOACs in the most frequent or the most challenging 6 NMBs. The secondary objective was to identify the factors that might influence the risk of bleedings according to the cardiologist point of view. Methods The survey was conducted in 2017 over two months, between September and November, among 218 liberal and/or hospital cardiologists practicing in metropolitan France and active at the time of the survey. Stratum sampling was carried out to ensure the representativeness of the cardiologists involved in the survey. An online questionnaire was sent to participants. It was made up of 3 sections: (1) “Epidemiology” of NMBs, (2) 6 Clinical cases on 6 NMBs: management of the patient and treatment? The NMBs considered were epistaxis, gingivorragia, subconjunctival haemorrhage, haematoma, rectal bleeding and hematuria. (3) Cardiologist's perception of NMBs and identification of factors influencing hemorrhagic risk. The statistical analysis was based on a descriptive analysis followed by a modeling that aimed at identifying the determinants of different DOAC treatment management. Conclusion The Hemicard survey provides data on French cardiologists practice and their management of DOAC treatments in NVAF patients with NMBs. This study will also help to better understand the impact of non-major bleedings in clinical practice.