Acute coronary syndromes - glycoprotein IIb/IIIa inhibitors (review)

Summary

A person who has unstable angina or who has had a mild heart attack should be given a small-molecule GP IIb/IIIa inhibitor as well as aspirin and unfractionated heparin (which helps to stop the blood from clotting) if he or she is thought to be at high risk of having a major heart attack or dying. This should happen early on in the patient’s treatment, and should happen whether or not the patient is soon going to have a PCI.

When a doctor is deciding whether a person is at high risk of having a major heart attack or dying, he or she should consider different factors, including:

• the person’s age and medical history (for example, whether there have been previous heart attacks or heart surgery)
• the person’s current state(for example, is he or she still in pain)
• the results of clinical tests such as an ECG (which shows if the heart is working abnormally) and blood tests

NICE has recommended that patients should be given a small-molecule GP IIb/IIIa inhibitor as soon as it appears that they are at high risk. The doctor shouldn’t wait until the results of a particular blood test called the cardiac troponin test are known if he or she thinks that, based on other factors, the patient is at high risk.

If a patient is scheduled to have a PCI soon after being admitted to hospital with unstable angina or a mild heart attack, but the operation is delayed, the patient should have a GP IIb/IIIa inhibitor at the time that she or he has the PCI.

Doctors should consider giving GP IIb/IIIa inhibitors to patients with diabetes who are having an elective PCI (which means that the operation is not being carried out in emergency circumstances). Doctors should also consider GP IIb/IIIa inhibitors for people who are having complex PCIs. GP IIb/IIIa inhibitors aren’t recommended for people who are having a planned, straightforward PCI unless there are immediate complications.

This guidance replaces Acute coronary syndromes – glycoprotein IIb/IIIa inhibitors (No. 12).

This guidance has replaced TA12Acute coronary syndromes - glycoprotein IIb/IIIa inhibitors.

Documents

For healthcare professionals

• TA47 Acute coronary syndromes - glycoprotein IIb/IIIa inhibitors (review): Guidance
• TA47 Acute coronary syndromes - glycoprotein IIb/IIIa inhibitors (review): Summary

For patients, carers and the public

• TA47 Acute coronary syndromes - glycoprotein IIb/IIIa inhibitors (review): Information for the public

Background information

• Review Decision - October 2007
• 2002/046 NICE updates glycoprotein IIb/IIIa inhibitor guidance for acute coronary syndromes
• Assessment Report: Glycoprotein IIb/IIIa inhibitor guidance for acute coronary syndromes
• Glycoprotein IIb/IIIa Modelling Report
• Review proposal - July 2005
• Review decision - September 2005
• Appendix A - Matrix of consultees and commentators.
• Review Proposal August 2007
• Acute coronary syndromes

Implementing this guidance

Any further information NICE has produced to help the NHS implement this guideline locally is linked to below:

• None found