The medical and scientific communities, appreciating the pivotal role of thrombosis in the evolution and expression of atherosclerotic coronary artery disease, have embarked upon intense efforts to develop safe, effective, and affordable thrombolytic agents and anticoagulants. With an understanding that more is not always better, these new compounds, mutants, and derivatives will be designed specifically to impair, neutralize, or enhance several key components of well-characterized thrombotic and fibrinolytic processes. If efforts continue at the current pace, one or more "designer" thrombolytics and anticoagulants will be ready for Phase II or Phase III clinical trials in the near future.