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

In the original NICE guideline, published in September 2000, Gp IIb/IIIa inhibitors were recommended for all patients undergoing PCI, whether acute or elective. 4 In the recently published revised guidance, 5 Gp IIb/IIIa inhibitors are recommended in many patient groups, including diabetic patients and acute coronary syndrome patients, but are no longer mandated in procedurally uncomplicated elective PCI where the risk of adverse events is low. In the recently published GUSTO V trial of standard dose reteplase versus half dose reteplase and full dose abciximab for the treatment of patients with ST segment elevation myocardial infarction, the 30 day mortality was 5.6% in the study group and 5.9% in the control group. 8 In a recent observational study in Yorkshire, which enrolled "all comers" with myocardial infarction, the 30 day mortality was 24%.\n 10 In all of these situations, the clinician has to balance the likely benefits and possible risks to the individual patient.