The field of thrombocardiology, dealing with the delicate balance between thrombotic complications and bleeding, is thought to be increasingly important in modern cardiology. Dramatic thromboembolic complications, such as myocardial infarction and stroke, have stimulated the development of a series of active drugs with inherent predisposition to serious bleeding. The EuroThrombosis Summit 2009 (8-10 October 2009, Oslo, Norway) provided an impressive update from leading authorities and researchers in the field. With the focus on basic mechanisms of thrombosis and bleeding, new antithrombotic drugs on the arena and 'in the pipeline', both for acute coronary syndromes and their long-term prophylaxis, were discussed in relation to efficacy and safety. The thrombotic mechanisms in atrial fibrillation mainly responsible for the threatening complication of stroke were also highlighted.