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Reasons for non-recruitment of eligible patients to a randomised controlled trial of secondary prevention after intracerebral haemorrhage: observational study

View Article: PubMed Central - PubMed

ABSTRACT

Background: Recruitment to randomised prevention trials is challenging, not least for intracerebral haemorrhage (ICH) associated with antithrombotic drug use. We investigated reasons for not recruiting apparently eligible patients at hospital sites that keep screening logs in the ongoing REstart or STop Antithrombotics Randomised Trial (RESTART), which seeks to determine whether to start antiplatelet drugs after ICH.

Method: By the end of May 2015, 158 participants had been recruited at 108 active sites in RESTART. The trial coordinating centre invited all sites that kept screening logs to submit screening log data, followed by one reminder. We checked the integrity of data, focused on the completeness of data about potentially eligible patients and categorised the reasons they were not randomised.

Results: Of 108 active sites, 39 (36%) provided usable screening log data over a median of ten (interquartile range = 5–13) months of recruitment per site. During this time, sites screened 633 potentially eligible patients and randomised 53 (8%) of them. The main reasons why 580 patients were not randomised were: 43 (7%) patients started anticoagulation, 51 (9%) patients declined, 148 (26%) patients’ stroke physicians were not uncertain about using antiplatelet drugs, 162 (28%) patients were too unwell and 176 (30%) patients were not randomised due to other reasons.

Conclusion: RESTART recruited ~8% of eligible patients. If more physicians were uncertain about the therapeutic dilemma that RESTART is addressing, RESTART could have recruited up to four times as many participants. The trial coordinating centre continues to engage with physicians about their uncertainty.

Trial registration: EU Clinical Trials, EudraCT 2012-003190-26. Registered on 3 July 2012.

No MeSH data available.


Graph showing reasons for 580 potentially eligible patients not being randomised
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Fig2: Graph showing reasons for 580 potentially eligible patients not being randomised

Mentions: The main reasons why the 580 patients were not randomised were: 43 (7%) patients started anticoagulation; 51 (9%) patients declined; 148 (26%) had stroke physicians who were not uncertain about using antiplatelet drugs; 162 (28%) patients were too unwell; and 176 (30%) patients were not randomised due to other reasons, for example, lived out of catchment area, transferred to a different hospital, lost to follow-up, enrolled in another drug trial, still under review, consented but not recruited or no clear reason was provided (Fig. 2).Fig. 2


Reasons for non-recruitment of eligible patients to a randomised controlled trial of secondary prevention after intracerebral haemorrhage: observational study
Graph showing reasons for 580 potentially eligible patients not being randomised
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC5382439&req=5

Fig2: Graph showing reasons for 580 potentially eligible patients not being randomised
Mentions: The main reasons why the 580 patients were not randomised were: 43 (7%) patients started anticoagulation; 51 (9%) patients declined; 148 (26%) had stroke physicians who were not uncertain about using antiplatelet drugs; 162 (28%) patients were too unwell; and 176 (30%) patients were not randomised due to other reasons, for example, lived out of catchment area, transferred to a different hospital, lost to follow-up, enrolled in another drug trial, still under review, consented but not recruited or no clear reason was provided (Fig. 2).Fig. 2

View Article: PubMed Central - PubMed

ABSTRACT

Background: Recruitment to randomised prevention trials is challenging, not least for intracerebral haemorrhage (ICH) associated with antithrombotic drug use. We investigated reasons for not recruiting apparently eligible patients at hospital sites that keep screening logs in the ongoing REstart or STop Antithrombotics Randomised Trial (RESTART), which seeks to determine whether to start antiplatelet drugs after ICH.

Method: By the end of May 2015, 158 participants had been recruited at 108 active sites in RESTART. The trial coordinating centre invited all sites that kept screening logs to submit screening log data, followed by one reminder. We checked the integrity of data, focused on the completeness of data about potentially eligible patients and categorised the reasons they were not randomised.

Results: Of 108 active sites, 39 (36%) provided usable screening log data over a median of ten (interquartile range = 5–13) months of recruitment per site. During this time, sites screened 633 potentially eligible patients and randomised 53 (8%) of them. The main reasons why 580 patients were not randomised were: 43 (7%) patients started anticoagulation, 51 (9%) patients declined, 148 (26%) patients’ stroke physicians were not uncertain about using antiplatelet drugs, 162 (28%) patients were too unwell and 176 (30%) patients were not randomised due to other reasons.

Conclusion: RESTART recruited ~8% of eligible patients. If more physicians were uncertain about the therapeutic dilemma that RESTART is addressing, RESTART could have recruited up to four times as many participants. The trial coordinating centre continues to engage with physicians about their uncertainty.

Trial registration: EU Clinical Trials, EudraCT 2012-003190-26. Registered on 3 July 2012.

No MeSH data available.