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

Abstract

We found a decline in compliance to NICE guidelines on GPI usage during PCI. This was likely influenced by contemporary trials demonstrating little or no benefit of GPI in patients undergoing elective PCI who are adequately pretreated with clopidogrel. Our findings suggest the need for a mechanism whereby regular updates to guidelines can be disseminated following new trial evidence.

ISAR - A Story of Trials With Impact on Practice -

“…15 After the results of the ISAR-REACT trial were published, noncompliance with the National Institute for Health and Clinical Excellence guidelines that recommended GP IIbIIIa inhibitors at that time increased from 11.0% to 42.1%. 16 Even in higher risk settings, such as small vessel size 17 and the presence of diabetes mellitus, 18 additional use of abciximab was not found to be beneficial in patients pretreated with 600 mg clopidogrel. In fact, in the Bavarian Reperfusion Alternatives Evaluation (BRAVE) 3 trial, patients with STEMI presenting within 24 h of symptom onset and receiving 600 mg clopidogrel did not benefit from upstream administration of abciximab in terms of reduction in infarct size.…”