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

All of the trials currently available looked at the glycoprotein (GP) IIb/IIIa inhibitors in conjunction with heparin, in line with their licensed indications. There is an ongoing trial (A-Z trial) looking at the use of tirofiban in conjunction with low-molecular-weight heparin (LMWH); INTERACT, another ongoing trial, is looking at a combination of eptifibatide with a LMWH (enoxaparin). As LMWH is widely used instead of standard heparin, the results of these trials are awaited with interest.

The effects of GP IIb/IIIa inhibitors in current UK practice should be investigated in carefully designed research to assess their benefits in non-ST-segment-elevation acute coronary syndrome (ACS) in patients who are not scheduled for percutaneous coronary intervention (PCI).

Research should be carried out to investigate the efficacy of GP IIb/IIIa inhibitors in subgroups such as women. A recently published meta-analysis of patient-level data has suggested that GP IIb/IIIa inhibitors may have no benefit in the medical management of ACS in women.

The results of the CURE trial may lead to a consideration of the use of clopidogrel for the management of patients with ACS. Research to establish the relative roles of the GP IIb/IIIa inhibitors and clopidogrel in the short-term management of patients with ACS will be necessary.

Research is needed to establish the statistical relationship between clinical risk factors and troponin levels, so as to assess the value added by the troponin result in the determination of risk level.