Major cardiovascular complications and ischemic events occur more frequentl
y in diabetic than nondiabetic patients. Platelets of diabetic patients are
found in a permanent prethrombotic state. Platelet activation and aggregat
ion with resultant arterial thrombus formation, are the central mechanisms
in the pathophysiology of acute coronary syndromes. Over the past two decad
es 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 o
bserved with daily dosis between 75 and 325 mg. In the last years some new,
very effective drugs have been developed. Clopidogrel, a thienopyridine wa
s studied in the CAPRIE trial and compared with aspirin. A small advantage
could be proved for clopidogrel. The development of inhibitors of fibrinoge
n, 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 demonstra
ted in Various clinical indications. The newest results show the clear adva
ntage of combining thrombolytic agents with the glycoprotein Ilb/IIIa recep
tor antagonists in reperfusion after myocardial infarction. In conclusion t
he main message is, that diabetic patients do need antithrombotic therapy e
arlier than nondiabetic patients, that efficient drugs are available and th
at a primary prevention should be considered in this special patient group.