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. The use of packed red blood cell transfusion to treat anemia might be reasonable in patients with aSAH who are at risk of cerebral ischemia. The optimal hemoglobin goal is still to be determined (Class IIb; Level of Evidence B). (New recommendation) 6. The use of fludrocortisone acetate and hypertonic saline solution is reasonable for preventing and cor- recting hyponatremia (Class IIa; Level of Evidence B). 7. Heparin-induced thrombocytopenia and deep ve- nous thrombosis are relatively frequent complica- tions after aSAH. Early identification and targeted treatment are recommended, but further research is needed to identify the ideal screening paradigms (Class I; Level of Evidence B). (New recommendation) Summary and Conclusions The management of aSAH is a complex undertaking, and the current state of knowledge is in rapid evolution. This update, which is based on a mere 42 months of publications, identified 22 new recommendations (Table 4), 5 of which were Class I recommendations. There were also 9 changes in prior recommendations. In total, there are now 22 Class I recommendations (Table 3). Although these data show that frequent revision of these guidelines is clearly needed, the data presented here only begin to scratch the surface of the burgeon- ing knowledge in this fast-developing field. Those faced with managing these patients will thus do well to use these guidelines as merely the starting point for doing everything possible to improve the outcomes of patients with aSAH. 