Cardiovascular disease is the leading cause of death worldwide. It is also an important cause of morbidity and hospitalization. Acute coronary syndrome is the most severe form of coronary artery disease, resulting in high mortality or recurrent coronary events, especially in developing countries. Anticoagulant therapy is a cornerstone of the management of acute coronary syndrome, especially with the advent of direct oral anticoagulants (DOACs).The choice of the appropriate anticoagulant therapy depends on several intrinsic and extrinsic factors related to each patient. For this reason, the learned societies of cardiology try to update the recommendations for the management of cardiovascular diseases on a daily basis.