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

Maxwell, Amy E. and MacLeod, Mary Joan and Joyson, Anu and Johnson, Sharon and Ramadan, Hawraman and Bellfield, Ruth and Byrne, Anthony and McGhee, Caroline and Rudd, Anthony and Price, Fiona and Vasileiadis, Evangelos and Holden, Melinda and Hewitt, Jonathan and Carpenter, Michael and Needle, Ann and Valentine, Stacey and Patel, Farzana and Harrington, Frances and Mudd, Paul and Emsley, Hedley and Gregary, Bindu and Kane, Ingrid and Muir, Keith and Tiwari, Divya and Owusu-Agyei, Peter and Temple, Natalie and Sekaran, Lakshmanan and Ragab, Suzanne and England, Timothy and Hedstrom, Amanda and Jones, Phil and Jones, Sarah and Doherty, Mandy and McCarron, Mark O. and Cohen, David L. and Tysoe, Sharon and Al-Shahi Salman, Rustam (2017) Reasons for non-recruitment of eligible patients to a randomised controlled trial of secondary prevention after intracerebral haemorrhage:observational study. Trials, 18 (1). ISSN 1745-6215

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.