ARTICLE

The glycoprotein IIb/IIIa inhibitors (GPIs) represent a relatively new therapy for acute coronary syndromes. In this article the authors share their experience with planning, implementing, and evaluating a protocol for GPI use in a community hospital. A working group conducted a literature review and recommended tirofiban as the formulary GPI; the working group also developed guidelines for use of the drug, including patient selection criteria. Medical records for 68 patients with unstable angina, admitted to the hospital over a 3-month period, were used to characterize the hospital’s patient population. Patient selection criteria included refractory ischemia or presentation with high-risk features such as chest pain at rest of less than 24 h duration, electrocardiographic changes, and troponin I level above 4.9 µg/L. Based on the hospital’s patient population, the annual estimated cost of treatment was almost $50,000. Drug use was evaluated for the first 20 patients treated with the drug. Eighteen (80%) of the patients receiving tirofiban met the predefined patient selection criteria. An outcomes assessment revealed that readmission for any reason and for acute myocardial infarction (within 7 and 30 days of discharge after admission for unstable angina) declined over time, although introduction of tirofiban was not the only factor in this change. The approach described here could be applied by other institutions considering the implementation of high-cost drug therapies. Key words: unstable angina, drug use evaluation, outcomes assessmen