Everyone knows that certain drugs may be contraindicated for patients with certain kinds of disorders. Everyone also knows that a drug's prescribing information and label specify patient groups that shouldn't receive it. What no one knows, however, is the extent to which health care professionals are following these label instructions.
   To help find out, researchers considered an example. They looked at the use of two antithrombotics—enoxaparin and eptifibatide—in dialysis patients who underwent percutaneous coronary intervention (PCI). (Antithrombotics are contraindicated in dialysis patients because of the increased risk of bleeding.)
   The researchers looked at data from almost 23,000 dialysis patients who underwent PCI at more than 800 hospitals from 2004 through 2008. They found that 22.3% of those patients received one of the contraindicated antithrombotics. Some patients received both drugs.
   The result? Dialysis patients who received one or both antithrombotics had a significantly higher rate of major in-hospital bleeding than similar patients who didn't receive these contraindicated drugs (5.6% versus 2.9%). These patients also had a higher death rate (6.5% versus 3.9%). (JAMA, 302[22]: 2458-2464)

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