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Introduction Glycoprotein IIb/IIIa inhibitors (GPIs) were initially used prior to angiography for acute coronary syndrome (ACS). Contemporary European Society of Cardiology (ESC) guidance restricts their indication to thrombotic complications, ‘no-flow’ or ‘slow-flow’ during percutaneous coronary intervention (PCI). We sought to ascertain the adherence of a district general hospital (DGH) without 24 hour on-site PCI to such guidelines.Methods A retrospective review (Jan 2020- Dec 2023) of consecutive patients receiving GPIs. Temporal changes in prescription and clinical use patterns were evaluated. Data presented as percentage change, proportions compared with chi-square and annual trend using Cochran-Armitage testing.Results Overall 129 patients, average age 63 ±12 years, 75% male (97/129) received GPIs with a median infusion duration of 35.9 hours (IQR:26–80). Chronic coronary syndrome (CCS), ST-elevation myocardial infarction (STEMI) and non-ST elevation myocardial infarction (NSTEMI) accounted for 2% (2/129), 46% (59/129) and 53% (68/129) respectively. In 2020 GPIs were used in 9% (30/328) of all PCI activity compared to 8% (27/319) in 2023,% change -11%, P= .8 (trend P= .4). ESC adherent ‘bail-out’ indications accounted for 47% (14/30) in 2020 versus 63% (17/27) in 2023,% change +34%, P= .2 (trend P= .06) and pre-angiography use in 23% (7/30) of cases in 2020 and 26% (7/27) in 2023,% change +13%, P= .8 (trend P= .9).Conclusions Clinical use patterns of GPIs have remained the same over the study period suggesting clinicians in a DGH setting may still regard GPIs as a useful adjunct outside of ESC guidance.