Acute coronary syndrome (ACS) is associated with high mortality even in the acute phase as well as in the post-acute (chronic) phase. Diabetes mellitus type 2 (DM-2), on the other hand, further increases mortality after ACS. Several new antiplatelet and antithrombotic drugs available for clinical use have also been investigated in patients with DM-2, and the guidelines of the European Society of Cardiology (ESC) were recently adapted. However, in daily clinical practice choosing the most suitable regimen is a challenge in many cases. This review article aims to shed light on and simplify antiplatelet and antithrombotic therapy in ACS patients with DM-2 in order to ease the clinician's decision-making.