Thrombotic events in diabetics contribute for almost 65-80% of cardiovascular events. Diabetes affects the platelet, the coagulation factors and fibrinolytic system leading to a state of hypercoagulation and hypofibrinolysis resulting in to thrombosis. Oral drugs commonly used in management of type II diabetes mellitus are antidiabetics like metformin, PPAR- γ agonist and DPP-4 inhibitor. They rarely produce hypoglycemia. Metformin has been proved to prevent release of mtDNA from arachidonic acid stimulated platelets, reduce membrane damage and mitochondrial ROS production in the platelets. Similarly processes like platelet adhesion, activation and aggregation on collagen coated surfaces which initiate thrombosis are prevented by metformin. PPAR- γ agonists like pioglitazone and rosiglitazone have anti atherogenic effect. They decrease the expression of inflammatory markers and affect the coagulation markers like factor VII: C and inhibit platelet activation. Pioglitazone also reduces the VLDL, triglycerides and increases HDL which further contributes in attenuation of atherosclerosis. DPP-4 inhibitors, which are relatively newer class of antidiabetics, having minimum potential for hypoglycemia induction, due to their novel mechanism of action. Studies have proved that long term use of DPP-4 inhibitors have reduced cardiac mortality by their lipid lowering action, increased release of NO from endothelium and inhibition of TNF- α, PAI-1 and VCAM expression. Increased levels of stromal cell derived factor - 1α helps to maintain endothelial homeostasis and vascular repair. Decreased oxidative stress, inhibition of inflammatory genes like IL- 6, IL-12, TNF- α provide additional benefit. Destabilization of vasculo-atherosclerotic plaque is prevented by DPP-4 inhibitors. Thus these oral antidiabetics drugs offer many benefits beyond blood glucose control which prevent atherosclerosis, inhibits hypercoagulable state and enhances fibrinolysis which translates into decreased cardiac complications in diabetes