Anti-thrombotic therapy is beneficial to patients with coronary heart diseases. The risk of hemorrhage is apparently increased in elderly patients with coronary artery disease compared with non-elderly patients while they benefited from the anti-thrombotic drugs. It is very important to understand the mechanism of these anti-thrombotic drugs and carefully balance the efficacy and safety of the anti-thrombotic therapy for elderly patients with coronary artery disease. In order to not only obtain the expected efficacy but also avoid the bleeding adverse events, it should be emphasized to monitor the side effect of bleeding and enable individualized dosage and strategy of the drug therapy.