Major cardiovascular complications and ischemic events occur more frequently in diabetic than nondiabetic patients. Platelets of diabetic patients are found in a permanent prethrombotic state. Platelet activation and aggregation with resultant arterial thrombus formation, are the central mechanisms in the pathophysiology of acute coronary syndromes. Over the past two decades aspirin was the leading antithrombotic agent for reduction of thrombotic events and efficacy was proven in many studies. The main study concerning the aspirin question was the "Antiplatelet Trialist's Collaboration-Study", where a successful risk reduction for vascular events of 25%-34% was observed with daily dosis between 75 and 325 mg. In the last years some new, very effective drugs have been developed. Clopidogrel, a thienopyridine was studied in the CAPRIE trial and compared with aspirin. A small advantage could be proved for clopidogrel. The development of inhibitors of fibrinogen, binding to the platelet glykoprotein IIb/IIIa receptor has expanded the therapeutic spectrum for the treatment of thrombotic disorders. Especially in diabetic patients a significant benefit of these new drugs was demonstrated in various clinical indications. The newest results show the clear advantage of combining thrombolytic agents with the glycoprotein IIb/IIIa receptor antagonists in reperfusion after myocardial infarction. In conclusion the main message is, that diabetic patients do need antithrombotic therapy earlier than nondiabetic patients, that efficient drugs are available and that a primary prevention should be considered in this special patient group.