Treatment of patients with acute coronary syndromes (ACS) incorporates several approaches to reverse or mitigate the thrombus, which invariably is at the center of the pathophysiologic process of ACS. Pharmacologic and mechanical strategies are designed to prevent death, reduce myocardial necrosis, and stabilize the plaque to prevent later sequelae. Conventional antithrombotic therapy includes antiplatelet and anticoagulant drugs. Medications that inhibit the platelet glycoprotein IIb/IIIa receptor have been shown to be especially efficacious in the treatment of ACS. Recent clinical trials have validated a strategy of aggressive revascularization, particularly catheter-based percutaneous procedures. This review summarizes new trial results and provides a working algorithm for care of the patient with ACS.