Abstract: Acute coronary syndrome (ACS) is a threatening disease and even worse when chronic kidney disease (CKD) is prevalent, which affects an ever-increasing proportion of ACS patients and is closely associated with major adverse cardiovascular events. Dual antiplatelet therapy is very important for early and long-term prognosis in ACS patients. As most drugs are eliminated by kidneys and patients with chronic renal insufficiency often have bleeding tendency and hypercoagulability states, proper use of antithrombotic drugs is significantly important for these patients. Most large randozmized controlled trials exclude those patients with CKD, making medical evidence for this subpopulation needing ACS antiplatelet therapy limited. This manuscript reviews studies concerning antithrombotic therapy for CKD with ACS.