Limitations
hypertension
CLOTS, CLOT, SUBARACHNOID HEMORRHAGE, MEDICAL COMPLICATION, HYPERTENSION
This trial has several limitations. First, we were unable to secure sufficient funding to allow timely completion of the EARLYDRAIN trial, prohibiting hiring of dedicated personnel.A significant number of patients in the lumbar drain group did not receive the allocated intervention for various reasons. Crossover patients did not reveal a particular pattern, and sensitivity analysis supported the findings from the intention-to-treat analysis. Patients, relatives, and acute care clinicians were not blinded to the intervention. Although this may be a source of bias, blinded outcome assessment of radiological imaging and clinical status at 6 months minimized this potential.We did not collect data on preexisting hypertension and other premorbid prognostic factors. We have no detailed information on the thickness of clots or the amount of intraparenchymal and intraventricular blood in the initial CT scan. We did not record medical complications during the clinical course, which happen frequently in patients with subarachnoid hemorrhage.The EARLYDRAIN trial did not investigate the additional application of clot thrombolysis or irrigation of the subarachnoid space. Also, we are unable to evaluate the benefit of possible higher drainage rates than the suggested 5 mL per hour, although some patients did have a higher drainage amount via lumbar route. This points to possible directions for future research.