Patients with continuing chest pain who are considered at high risk and would benefit from early coronary revascularisation should receive glycoprotein IIb/IIIa inhibitors. Those with the following features are at particularly high risk of infarction or death:

• Recurrent ischaemia (symptoms) – ongoing ischaemic chest pain

• Recurrent ischaemia (ECG changes) – ST-segment depression- T-wave inversion

• Troponin I elevated > 0.4 ng/ml

• Impaired LV function (echo or clinical) – pulmonary oedema

• Arrhythmia (VT/VF)

In the presence of ongoing coronary ischaemia, patients who fulfil three of these criteria should be considered for glycoprotein IIb/IIIa inhibitors.

Administration of tirofiban

• LMW heparin should continue to be administered as above

• Monitor the haemglobin and platelet count before treatment at 6 hours, and once daily following infusion.

Contraindications to tirofiban

• Known or suspected active peptic ulceration within 3 months

• Stroke within 30 days

• Any history of haemorrhagic stroke, previous neurosurgical procedure, intracranial aneurysm, neoplasm, AVM or subarachnoid haemorrhage.

• Patients with defective haemostatis (includes patients on warfarin)

• Severe liver or renal disease

• Bacterial endocarditis, acute pancreatitis

• Pregnancy/Lactation