Abstract Background: Acute Coronary Syndromes (ACS) patients with thrombocytopenia are challenging in their management as they carry high bleeding and thrombotic risks. Aim of Study: In this study we aimed to assess the impact of thrombocytopenia on ACS patients. Patients and Methods: We collected data of 608 ACS patients who presented to our hospital during the year 2017. Patients were divided into 2 groups according to the presence of initial thrombocytopenia: Group 1 with initial thrombocy-topenia (n=123) and group 2 without initial thrombocytopenia (n=485). Platelet count less than or equal 150.000/ml was used to define thrombocytopenia. Endpoints were in-hospital and 6 months Major Adverse Cardiovascular and Cerebrov-ascular Events (MACCE). Results: Group 1 patients were significantly older and, more likely with a history of acute coronary syndrome (38.2% versus 26.7%, p=0.049), and more likely to present as non ST elevation myocardial infarction (39% versus 26.7%, p=0.037). In hospital outcome showed significantly higher risk of cumulative MACCE in group 1 patients (12.2% versus 2.3%, p=0.002) and a similar result was found after at least 6 months follow-up (19.3% versus 9.6%, p=0.041). Both groups had similar incidence of bleeding and heart failure. Group 1 patients had significantly higher incidence of in hospital MACCE (p=0.038), but this was not significant after 6 months follow-up. Conclusions: ACS patients with mild thrombocytopenia had similar bleeding risk in comparison to patients with normal count during the hospital stay and after 6 months of follow-up, higher risk of in hospital MACCE and so they should be managed as patients with normal platelet counts.