Here, from 1,200 consecutively treated patients, complete information was available for 1,104 patients, and 51% of patients were treated despite license contraindications.
Two other studies (38, 40) of sicker patients admitted to hospitals in Germany and the U.S. confirmed high frequency of metformin use despite various contraindications (73 and 27%, respectively).
For example, in a review (41) of restrictions to metformin therapy conducted in Scotland, 24.5% of metformin users had filled a prescription despite active contraindications (3.4% had the specific local exclusion of a serum creatinine ≥1.7 mg/dL recorded twice on different days within 4 weeks).
Despite this contraindication, uncomplicated IRE-procedures in previously stented patients with locally advanced pancreatic carcinoma have been reported (data presented at CIRSE 2013 by G. Narayanan, University of Miami, Miller School of Medicine).
Despite this contraindication, the first cases of congenital anomalies after isotretinoin use during pregnancy were documented already in 1983. 2 As described by Lammer et al 3 in 1985, isotretinoin embryopathy consists of craniofacial, cardiac, thymic and central nervous system defects.
These results were confirmed in a large cohort of diabetic patients treated with metformin despite various metformin contraindications, in which no MALA has been described by the authors [2].
In conclusion, we observed that early mobilization is achievable and well tolerated in the vast majority of critically ill patients, despite commonly described contraindications such as MV, vasopressor administration, and RRT.
Another physician added that due to the lack of updated information (eg, pregnancy) in relation to patients, medicines might have been prescribed to them despite there being contraindications.
A missed opportunity occurs when an individual eligible for vaccination has contact with a health facility and does not receive a needed vaccine, despite having no contraindications.
In the aforementioned U.S. primary practice setting, where 4.5% of patients were given metformin despite creatinine-based contraindications, 17.7% of women and 13.4% of men receiving metformin actually had an abnormally low eGFR (≤60 mL/min per 1.73 m) (42).
