About 120 000 people are diagnosed with acute coronary syndrome in England and Wales each year, and about 1.5 million people are discharged from hospitals in the United States with the diagnosis.1 Despite the use of standard medical treatment, the risk of death or non-fatal myocardial infarction is about 10% within 30 days, and the proportion of adverse outcomes is about 30% at six months.2

Doctors who deal with acute medical admissions are well accustomed to the diagnosis and initial medical management of acute coronary syndromes. However, many doctors are less confident about the use of glycoprotein IIb/IIIa inhibitors, such as eptifibatide and tirofiban, in these patients and often await a cardiology review.3 This may be less important in tertiary centres where a specialist opinion is prompt and patients at high risk are quickly identified and stratified to invasive strategies or coronary care units. In district general hospitals, however, the admitting doctor decides which patients could benefit from more aggressive strategies. This is especially true out of normal working hours, when the cardiology team is not available. Moreover, recent data from the myocardial infarction national audit project suggest that most patients with acute coronary syndrome are initially managed by non-cardiologists on acute wards.4

Glycoprotein IIb/IIIa inhibitors inhibit the final common pathway of platelet aggregation, so they …