Major recent advances in the development of preventative and therapeutic approaches in atherothrombotic disease has prompted this Theme Issue of Thrombosis and Haemostasis. We are currently witnessing a fascinating introduction of novel antithrombotic agents into clinical practice, which will probably result in the disappearance of some drugs, which generations of physicians and patients have learned to live with, including all their advantages and disadvantages. Indeed, warfarin has been synonymous with oral anticoagulation as is heparin for intravenous anticoagulation. Hopefully, both may soon be replaced by new agents – broadly the oral direct thrombin inhibitors or oral factor Xa inhibitors – that provide major benefits for patients. Also anti-platelet therapy will change with the availability of a plethora of different agents already approved or currently in clinical trials or in development, including prasugrel or ticagrelor. Finally, the therapeutic potential of stem cell therapy (see upcoming Theme Issue by Guest Editor H. F. Tse) for the clinical consequences of atherothrombosis, myocardial infarction, has attracted major interest but also major controversy. Freudenberger et al. start off this Theme Issue with a systematic assessment of the clinical data available for anticoagulation therapy in patients with heart failure (1). The latter is commonly seen in clinical practice, and many complications associated with heart failure can be thrombosisrelated. Oral anticoagulation with warfarin or other vitamin K antagonists are associated with a high rate of bleeding complications as well as therapeutic failures. For decades, these shortcomings have initiated major drug development programs in the pharmaceutical industry. However, only recently advances in the understanding of serine protease biology and sophisticated drug development tools have resulted in long soughtafter successful drug development programs. Of the drugs in development, the direct thrombin inhibitor dabigatran and the direct factor Xa inhibitors rivaroxaban and apixaban are amongst those most advanced. In this issue, Ufer et al. provide a thorough comparison of these agents (2). One of the most fascinating drug developments in the field of anticoagulation is the generation of nucleid acid aptamers as described in a detailed review by Becker et al. (3). Specific three-dimensional structures of small RNA or DNA single-stranded molecules allow the blockade of enzyme function. Using a powerful screening technology, nucleic acid combinatorial libraries are incubated with the coagulation protease to be targeted. High-affinity blockers are then amplified by repeated screening rounds. The first aptamer developed for humans targets factor IXa and indeed this aptamer has successfully passed a phase 1 trial and overall looks promising. One of the biggest advantages of the aptamer technology is the technology-inherent availability of an antidote, which is composed of the antisense strand of the respective DNA or RNA sequence. In this, the aptamer technology is clearly superior to other drug developments in the field of anticoagulation or anti-platelet therapy where an antidote is typically not available. Personalised pharmacotherapy has long been discussed but rarely performed in Correspondence to: Prof. Karlheinz Peter Baker Heart Research Institute Centre for Thrombosis & Myocardial Infarction PO Box 6492, St Kilda Road Melbourne, 8008 Victoria, Australia Fax: +61 3 8532 1160 E-mail: Karlheinz.Peter@bakeridi.edu.au