Antithrombotic therapy with aspirin, ADP receptor blockers and anticoagulants currently forms the basis of pharmacological
treatment in acute ST elevation myocardial infarction (STEMI) patients. Several new ADP receptor blockers
with more favorable drug profile have been recently introduced. These include two oral agents – prasugrel and
ticagrelor – that should be preferred over clopidogrel; and a venous agent cangrelor that may be administrated in
patients who are not pretreated with an oral agent. In addition, enoxaparin and bivalirudin have been approved for
anticoagulation in acute STEMI patients planned for invasive strategy; and enoxaparin and fondaparinux may be
considered as alternative agents to heparin in patients planned for conservative treatment. This article reviews the
current approaches to antithrombotic therapy in patients with acute STEMI.