Unstable angina is the most frequent acute coronary syndrome. Risk stratification to predict coronary morbidity and mortality and the risk of major haemorrhage are the key steps of the medical approach. Combined antithrombotic therapy (including aspirin, clopidogrel, low-molecular weight heparins and, eventually glycoprotein IIb/IIIa receptor antagonists) has led to a substantial reduction of major coronary events with a good tolerance because of the short duration of such aggressive strategy. This combined antithrombotic also allowed to increase the benefit of an early invasive strategy including coronary angiogram with stent percutaneous coronary angioplasty.