In patients with NSTE-ACS and high-risk features (eg, elevated troponin) treated with UFH and ad- equately pretreated with clopidogrel, it is reasonable to administer a GP IIb/IIIa inhibitor (abciximab, double-bolus eptifibatide, or high-dose bolus tirofi- ban) at the time of PCI.195,383 (Level of Evidence: B) GP IIb/IIIa receptor antagonist therapy in patients with NSTE-ACS undergoing PCI reduced the incidence of com- posite ischemic events, primarily through a decrease in documented MI, although in some trials this is counter- balanced by an increased rate of bleeding.193,195,310,379 382,392 Most, but not all, randomized trials of the use of GP IIb/IIIa inhibitor were conducted in the era before clopidogrel Abciximab, double-bolus eptifiba- tide, and high-bolus dose tirofiban result in a high degree of platelet inhibition, reduce ischemic complications in patients undergoing PCI, and appear to afford comparable angio- graphic and clinical outcomes.26 As trials of the GP IIb/IIIa inhibitors generally excluded patients at high risk of bleed- ing, recommendations for the use of GP IIb/IIIa inhibitors are best understood as applying to patients not at high risk of bleeding complications. Although GP IIb/IIIa inhibitors were used in 27% and 55% of patients, respectively, in the PLATO (Platelet Inhibition and Patient Outcomes) and TRITON studies of ticagrelor and prasugrel, there are insufficient (and no RCT data) from which to make specific recommendations about GP IIb/IIIa inhibitor use in patients treated with either of these P2Y12 inhibitors. See Online Data Supplement 21 for additional information on GP IIb/IIIa inhibitors. 5.1.2.3. Anticoagulant Therapy in Patients Undergoing PCI: Recommendations Class I 1. An anticoagulant should be administered to patients with NSTE-ACS undergoing PCI to reduce the risk of intracoronary and catheter thrombus formation. (Level of Evidence: C) 2. Intravenous UFH is useful in patients with NSTE- ACS undergoing PCI. (Level of Evidence: C) 3. 