Who would I not give IIb/IIIa inhibitors to during percutaneous coronary intervention?

Coronary artery stenting and platelet IIb/IIIa receptor antagonists confer complementary benefits on patients undergoing percutaneous coronary intervention (PCI). Glycoprotein (Gp) IIb/IIIa inhibitors make the procedure safer by reducing periprocedural complications such as myocardial infarction, while stenting reduces restenosis rates and the need for further revascularisation procedures. If Gp IIb/IIIa inhibitors make PCI safer, then should every PCI patient receive a Gp IIb/IIIa inhibitor? It is difficult to argue against this. Studies of Gp IIb/IIIa inhibitors with mandatory PCI have almost invariably shown benefit from active treatment; within these studies, multiple subgroup analyses have generally shown increased benefit in specific subgroups, particularly among diabetics patients and those with raised troponin concentrations. No subgroup analysis, however, has identified a group of patients that is harmed by adjunctive Gp IIb/IIIa inhibitor treatment during PCI.