Recent European Society of Cardiology (ESC) Guidelines have extensively investigated antithrombotic therapy during percutaneous coronary interventions (PCI)1-3. However, based on their complexity and partial difference from existing ACC/AHA guidelines, it is sometimes difficult to follow them in individual decisions. Moreover, most of the recommendations are based on prospective randomised trials, which only partially reflect the “real world” situation. Meta-analyses and guideline-based registries might help to guide daily practice. With respect to cardiovascular interventions the combination of both anticoagulant and antiplatelet therapies is mandatory to prevent thrombosis, because activation of both platelets and the coagulation system contribute to thrombus formation. The choice, initiation and duration of antithrombotic strategies is based on the clinical setting (elective, acute or urgent intervention). To optimise efficacy of therapy and reduce the potential bleeding hazard both, ischaemic and bleeding risks, have to be evaluated on an individual basis. The present report aims to give practical solutions to handle antithrombotic therapy for patients undergoing PCI in various clinical conditions.