Platelet aggregation and thrombus formation secondary to plaque disruption at the sites of coronary atheroma play a prominent role in the pathophysiology of acute coronary syndromes. A fundamental role of cell adhesion molecules are implicated for the disease process of these syndromes. These adhesion molecules play a active role in cell-extracellular matrix interaction and cell-cell interaction at the first step of the thrombus formation at the culprit lesion of the coronary artery. A more comprehensive understandings of adhesion molecules and their functions may promote the development of potentially more effective therapeutic strategies for the syndromes. This review focuses on the role of platelet glycoprotein Ib, IIb/IIIa and P-selectin in the thrombotic process.