Early management of unstable angina and non-ST segment elevation myocardial infarction: summary of NICE guidance.

antiplatelet treatment Offer a single loading dose of 300 mg aspirin as soon as possible and continue indefinitely unless contraindicated by bleeding risk or aspirin hypersensitivity. [Based on a high quality systematic review and cost effectiveness evidence] Offer a loading dose of 300 mg clopidogrel in addition to aspirin to patients with a predicted six month mortality of more than 1.5%, or to patients who may undergo percutaneous coronary intervention within 24 hours of admission to hospital, unless contraindications (for example, excessive risk of bleeding) exist. [Based on moderate to high quality evidence from randomised controlled trials (RCTs) and cost effectiveness evidence] Consider adding an intravenous glycoprotein IIa/IIIb inhibitor (eptifibatide or tirofiban) as part of early management for patients at intermediate or higher risk (predicted six month mortality >3.0%) who are scheduled to undergo coronary angiography (and follow-on percutaneous coronary intervention if indicated) within 96 hours of hospital admission. (This is an off-label use of eptifibatide and tirofiban, which do not have marketing authorisation for use with clopidogrel in the United Kingdom.) [Based on high quality systematic reviews, RCTs, and cost effectiveness evidence] When determining whether a glycoprotein IIb/IIIa inhibitor should be offered, balance the potential reduction in ischaemic risk with any increased risk of bleeding. [Based on evidence from moderate to high quality systematic reviews and the experience and opinion of the GDG] Guidelines