The early identification of patients with a history of an acute coronary event, exposed to an elevated risk of new ischemic events, is a fundamental step to reduce the residual risk and to restrict healthcare expenses. Effective measures in terms of antithrombotic treatment and secondary prevention are currently available to reach these objectives. In particular, the use of dual antiplatelet therapy both in the 12 months after an acute event and in the long term is highly effective in reducing

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... ntithrombotic complications in patients with a previous acute event. The turning point in the therapeutic management of these subjects is the correct identification of the residual ischemic risk and of the potential risk of bleeding in order to optimize the therapeutic choice selecting the most adequate, efficacious, and safe approach to improve long-term prognosis. The aim of the present article is to summarize the characteristics and the relevance of the currently available antithrombotic strategies to adopt in patients with a previous acute coronary event, focusing the attention on the importance of ischemic residual risk reduction in the long term.