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Guidelines to Practice Gap in the Use of Glycoprotein IIb/IIIa Inhibitors: From ISAR-REACT to Overreact ?

Lookup NU author(s): Dr Girish Viswanathan, Sajid Javed, Sheila Jamieson, Professor Azfar Zaman


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Adjunctive use of glycoprotein IIb/IIIa inhibitors (GPI) is associated with favorable outcomes following percutaneous coronary intervention (PCI). Guidelines for use of GPI have been published by various national societies including National Institute of Clinical Excellence (NICE), United Kingdom. The latter has not been updated since publication. The impact of contemporary trials such as ISAR-REACT (which showed no benefit of abciximab and 600 mg of clopidogrel compared with 600 mg of clopidogrel alone, in elective patients) on adherence to NICE guidelines is unknown. Methods: We audited use of GPI against NICE guidelines following publication in May 2002. Data were collected from 1,685 patients between September and November in years 2002, 2003, 2004, and 2007. Results: In 2002 and 2003, only 10.2% and 11.8%, respectively, of patients were noncompliant to NICE guidelines. Over time, there was an increase in patients not given GPI despite meeting NICE criteria. After publication of ISAR-REACT, the comparative figures for noncompliance in 2004 and 2007 were 40.0% and 44.5%. A similar pattern was seen in patients with diabetes; in 2002 and 2003 noncompliance was 16.7% and 11.1%, respectively, and in 2004 and 2007 noncompliance was 38.0% and 44.7%, respectively. Qualitatively, similar findings were recorded in patients with NSTE-ACS. The overall noncompliance to NICE guidelines increased from 11.0% to 42.1% (P

Publication metadata

Author(s): Viswanathan G, Javed S, Mayurathan G, Sallehuddin S, Jamieson S, Zaman AG

Publication type: Article

Publication status: Published

Journal: Journal of Interventional Cardiology

Year: 2009

Volume: 22

Issue: 2

Pages: 163-168

ISSN (print): 0896-4327

ISSN (electronic): 1540-8183

Publisher: Wiley-Blackwell Publishing, Inc.


DOI: 10.1111/j.1540-8183.2009.00425.x


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Funder referenceFunder name
FS/033/07British Heart Foundation