Antithrombotic therapy represents an important part of complex therapy in acute coronary syndromes without ST segment elevation (NSTEACS). Both anticoagulation and antiplatelet therapy is needed in every NSTEACS patient. In appropriate choice of an anticoagulation agent, initial risk stratification is very important. Anticoagulant should be selected according to the risk of both thrombotic and bleeding complications. In an urgent coronary angiography, unfractioned heparin (UFH), enoxaparin, or bivalirudin should be immediately started. In case of non urgent strategy, fondaparinux is recommended. Dual antiplatelet therapy is indicated in all NSTEACS for 12 months. Moreover in high risk patients IIb/IIIa receptor blocker is recommended.