Acute Coronary Syndrome (ACS) is one of the major causes of death worldwide, including unstable angina, ST-segment elevation myocardial infarction and NST-segment elevation myocardial infarction. ACS refers to a series of life-threatening heart diseases, which is caused by rupturing coronary plaque and releasing thrombin activation. Then thrombin is activated and generates plaque and thrombosis, which increases the risk of cardiac death and myocardial infarction. Aggressive and conservative treatment is available in clinic practice. Anticoagulant therapy is usually the first choice for conservative treatment and used in combination with dual antiplatelet drugs, which plays an important role in the treatment of acute coronary syndrome. Fondaparinux as a commonly used anticoagulant drug is both antithrombotic effectively and can reduce the risk of bleeding and coronary microvascular dysfunction in the pathogenesis of ischemic heart disease. However, it increased the rate of bleeding. People pay more attention to the role of long-term prognosis. Domestic and foreign researches contrast outcomes of acute coronary syndrome of fondaparinux and low molecular weight heparin.