Therapy

Add tirofiban ^a or eptifibatide ^a

Why?

• Patients with severe unstable angina (ECG changes or cardiac enzyme elevation) who receive eptifibatide are less likely to die or have non-fatal MI, but more likely to have severe bleeding. ^a   Eptifibatide is cost-effective. ^a
• Patients with severe unstable angina (ECG changes or cardiac enzyme elevation) who receive tirofiban and heparin compared with heparin alone are less likely to have an MI or refractory ischaemia. ^a

Tirofiban and eptifibatide reduces myocardial infarction

Patient	Treatment	Comparison	Outcome	CER	RRR (95% CI)	NNT (95% CI)
severe unstable angina or non-Q wave MI   a	eptifibatide plus standard therapy	standard therapy	death, non-fatal MI or refractory angina at 30 days	16%	9.0% (0.0% to 18%)	67 (34 to 1900)
severe unstable angina or non-Q wave MI	eptifibatide plus standard therapy	standard therapy	severe bleed at 30 days	0.89%	-67% (-150% to -14%)	-170 (-620 to -96)
severe unstable angina or non-Q wave MI a	tirofiban and heparin	heparin	refractory ischaemia at 7 days	9.3%	27% (2% to 44%)	30 (15 to 380)
severe unstable angina or non-Q wave MI	tirofiban and heparin	heparin	MI at 7 days	3.9%	45% (15% to 64%)	32 (18 to 110)