Guidance on the use of glycoprotein IIb/IIIa inhibitors in the treatment of acute coronary syndromes

Abciximab is a monoclonal antibody that targets the glycoprotein (GP) IIb/IIIa receptor on the surface of platelets.

Abciximab is indicated as an adjunct to aspirin and heparin for the prevention of ischaemic complications in patients undergoing percutaneous coronary intervention (PCI). It is also indicated for the short-term (1 month) reduction of risk of myocardial infarction (MI) in patients who have unstable angina that is not responding to full conventional therapy and who are to undergo PCI. Abciximab is administered intravenously at an initial bolus dose of 250 microgram/kg body weight followed by a maintenance dose of 0.125 microgram/kg/min (maximum 10 microgram/min) over 12 to 36 hours.

As with the other GP IIb/IIIa inhibitors, the side effects of abciximab (including bleeding and thrombocytopenia) are related to its pharmacological effects. For full details of side effects and contraindications, see the summary of product characteristics.

The cost of abciximab is £280 (net) for a 10‑mg vial (BNF 43rd edition). For a 70‑kg person, the cost per course ranges from £840 to £1,120, depending on the duration of treatment (costs rounded to full vials).

Eptifibatide is a synthetic cyclic heptapeptide and is 1 of the small-molecule GP IIb/IIIa inhibitors. It reversibly inhibits platelet aggregation by preventing the binding of fibrinogen and other adhesive ligands to the GP IIb/IIIa receptor.

Eptifibatide is indicated for the prevention of early MI in patients presenting with unstable angina or non-Q-wave MI (NSTEMI) who have had chest pain within the last 24 hours and who have electrocardiogram (ECG) changes and/or elevated cardiac enzymes. It is administered intravenously at an initial bolus dose of 180 microgram/kg followed by a maintenance dose of 2.0 microgram/kg/min for up to 72 hours (up to 96 hours if the patient has a PCI during treatment).

As with the other GP IIb/IIIa inhibitors, the side effects of eptifibatide (including bleeding and thrombocytopenia) are related to its pharmacological effects. For full details of side effects and contraindications, see the summary of product characteristics.

The cost of eptifibatide is £15.54 (net) for a 20‑mg vial and £48.84 (net) for a 75‑mg vial (BNF 43rd edition). For a 70‑kg person, the cost per course ranges from £455 to £553, depending on the duration of treatment (costs rounded to full vials).

Tirofiban is a non-peptidal antagonist of the GP IIb/IIIa receptor and is 1 of the small-molecule GP IIb/IIIa inhibitors. It prevents fibrinogen from binding to the GP IIb/IIIa receptor, thus blocking platelet aggregation.

Tirofiban is indicated for the prevention of early MI in patients presenting with unstable angina or NSTEMI who have had chest pain within the last 12 hours and who have ECG changes and/or elevated cardiac enzymes. It is administered intravenously at an initial dose of 0.4 microgram/kg/min for 30 minutes followed by a maintenance dose of 0.1 microgram/kg/min for at least 48 hours, up to a maximum duration of treatment of 108 hours.

As with the other GP IIb/IIIa inhibitors, the side effects of tirofiban (including bleeding and thrombocytopenia) are related to its pharmacological effects. For full details of side effects and contraindications, see the summary of product characteristics.

The cost of tirofiban is £146.11 (net) for a 12.5‑mg vial (BNF 43rd edition). For a 70‑kg person, the cost per course ranges from £292 to £584, depending on the duration of treatment (costs rounded to full vials).