NICE guidance - glycoprotein IIb/IIIa for unstable angina and NSTEMI

Last reviewed 01/2018

Glycoprotein IIb/IIIa inhibitors

• intravenous eptifibatide or tirofiban should be considered as part of the early management for patients who have an intermediate or higher risk of adverse cardiovascular events (predicted 6-month mortality above 3.0%), and who are scheduled to undergo angiography within 96 hours of hospital admission
• abciximab should be considered as an adjunct to PCI for patients at intermediate or higher risk of adverse cardiovascular events who are not already receiving a GPI

Notes:

• as soon as the diagnosis of unstable angina or NSTEMI is made, and aspirin and antithrombin therapy have been offered, formally assess individual risk of future adverse cardiovascular events using an established risk scoring system that predicts 6-month mortality (for example, Global Registry of Acute Cardiac Events [GRACE])
  • include in the formal risk assessment:
    • a full clinical history (including age, previous myocardial infarction [MI] and previous percutaneous coronary intervention [PCI] or coronary artery bypass grafting [CABG])
    • a physical examination (including measurement of blood pressure and heart rate)
    • resting 12-lead electrocardiography (ECG) (looking particularly for dynamic or unstable patterns that indicate myocardial ischaemia)
    • blood tests (such as troponin I or T, creatinine, glucose and haemoglobin)

• Predicted 6-month mortality	Risk of future adverse cardiovascular events
  1.5% or below	lowest
  > 1.5 to 3.0%	low
  > 3.0 to 6.0%	intermediate
  > 6.0 to 9.0% over 9.0%	high
  over 9.0%	highest

Reference:

• 1) NICE (March 2010). Unstable angina and NSTEMI The early management of unstable angina and non-ST-segment-elevation myocardial infarction