Atherosclerosis often starts in late adolescence or early adulthood. Clinical manifestations including coronary artery disease, stroke, and peripheral vascular disease occur years later. Ischemic coronary artery disease has a variety of presentations, including stable angina, unstable angina, non-ST-segment-elevation myocardial infarction (NSTEMI) and STEMI. Antiplatelet therapy as on today has evolved over a century. Prior to 1882, platelets were just thought of as dust particles. Antiplatelet therapy as on today is not confined to just age old aspirin. Today various targets or legends on platelets are attacked by different drugs paving way for double or even triple antiplatelet therapy in relevant clinical conditions. A pharmacological classification of antiplatelet drugs is given. Pathophysiology of atherothrombosis—role of platelets, antiplatelet therapy, ADP receptor blockers—thienopyridines, and glycoprotein IIA/IIB receptor blockers are discussed. Novel drugs, with special reference to prasugrel, prasugrel, and future trends are described.