Table 5Detailed strength of evidence for UA/NSTEMI patients treated with upstream versus deferred glycoprotein inhibitor

Number of Studies (Patients)DomainsStrength of Evidence
Magnitude of Effect
Effect Estimate (95% CI)
Risk of Bias: Study Design/QualityConsistencyDirectnessPrecision
Composite of All-Cause Mortality, Nonfatal MI, or Revascularization at 30 DaysLow SOE
6 (19,662)6 RCTs/2 good quality, 3 fair, 1 poorConsistentDirectImpreciseOR 0.88 (0.77 to 1.01)
No difference
Composite of All-Cause Mortality, Nonfatal MI, or Revascularization After 6 MonthsInsufficient SOE
4 (773)4 RCTs/All fair qualityConsistentDirectImpreciseOR 0.77 (0.46 to 1.28)
All-cause Mortality at 30 DaysInsufficient SOE
10 (20,521)10 RCTs/3 good quality, 5 fair, 2 poorInconsistentDirectImpreciseOR 0.80 (0.57 to 1.11)
All-Cause Mortality at 6 MonthsInsufficient SOE
3 (673)3 RCTs/All fair qualityInconsistentDirectImprecise1 study reported no deaths in both arms; 1 study reported 1 death in the upstream GPI arm; 1 study reported similar rates (2.0% upstream GPI, 3.6% deferred GPI)
Nonfatal MI at 30 DaysInsufficient SOE
9 (20,263)9 RCTs/3 good quality, 5 fair, 1 poorInconsistentDirectImpreciseOR 0.84 (0.65 to 1.10)
Nonfatal MI at 6 MonthsInsufficient SOE
3 (673)3 RCTs/All fair qualityInconsistentDirectImprecise1 study reported 1 MI in the deferred GPI arm only; 2 other studies reported MI rates of 12% upstream vs. 15% deferred, and 10% upstream and 9% deferred
Revascularization at 30 DaysHigh SOE
6 (19,454)6 RCTs/3 good quality, 3 fairConsistentDirectPreciseOR 0.77 (0.65 to 0.92)
Favors upstream GPI
Revascularization at 6 MonthsInsufficient SOE
3 (673)3 RCTs/3 fair qualityInconsistentDirectImpreciseOR 0.69 (0.34 to 1.39)
Major Bleeding at 30 DaysHigh SOE
9 (20,242)9 RCTs/2 good quality, 5 fair, 2 poorConsistentDirectPreciseOR 1.24 (1.08 to 1.43)
Favors deferred GPI
Minor Bleeding at 30 DaysInsufficient SOE
5 (969)5 RCTs/All fair qualityInconsistentDirectImpreciseOR 1.58 (0.95 to 2.64)
Stent thrombosis at 30 DaysInsufficient SOE
0NANANANANA

CI = confidence interval; GPI = glycoprotein inhibitor; MI = myocardial infarction; NA = not applicable; OR = odds ratio; RCT = randomized controlled trial; SOE = strength of evidence; UA/NSTEMI = unstable angina/non-ST elevation myocardial infarction

From: Results

Cover of Antiplatelet and Anticoagulant Treatments for Unstable Angina/Non–ST Elevation Myocardial Infarction
Antiplatelet and Anticoagulant Treatments for Unstable Angina/Non–ST Elevation Myocardial Infarction [Internet].
Comparative Effectiveness Reviews, No. 129.
Melloni C, Jones WS, Washam JB, et al.

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