Patients with heparin-induced thrombocytopenia type II appear to have higher rates of thrombotic complications and symptom- atic vasospasm/DCI, more deaths, and significantly less favor- able outcomes. It is currently unclear whether there is a practical means of preventing heparin-induced thrombocytopenia, given the need for heparin in many angiographic procedures, but it is clearly important to recognize this complication to avoid further heparin exposure and to use instead a nonheparin alternative under the guidance of a hematologist.336 By comparison, deep venous thrombosis has long been recognized as a relatively frequent occurrence after aSAH, especially in patients immobi- lized because of poor mental status.337,338 Nevertheless, in examining cohorts in which routine prophylaxis (subcutaneous heparinoids and external pneumatic compression sleeves) was used, recent data suggest that although screening protocols may identify additional cases of asymptomatic thrombosis, there is no significant difference in the incidence of pulmonary embolism between those screened and those not screened. Management of Medical Complications Associated With aSAH: Recommendations 1. Administration of large volumes of hypotonic fluids and intravascular volume contraction is not recom- mended after aSAH (Class III; Level of Evidence B). 2. Monitoring volume status in certain patients with recent aSAH by some combination of central venous pressure, pulmonary wedge pressure, and fluid bal- ance is reasonable, as is treatment of volume con- traction with crystalloid or colloid fluids (Class IIa; Level of Evidence B). 3. Aggressive control of fever to a target of normothermia by use of standard or advanced temperature modulat- ing systems is reasonable in the acute phase of aSAH (Class IIa; Level of Evidence B). (New recommendation) 4. Careful glucose management with strict avoidance of hypoglycemia may be considered as part of the general critical care management of patients with aSAH (Class IIb; Level of Evidence B). 5. 