Aim. To investigate whether the nitric oxide (NO)/cyclic GMP (cGMP) signalling pathway, in basal conditions and stimulated by sodium nitroprusside (SNP), may disclose abnormal patterns in platelets from patients with an acute coronary syndrome.Design. Platelet activation (sP-selectin), inflammation (TNF-α and erythrosedimentation rate), thrombotic state (fibrinogen) and plaque disruption (HsCRP) markers were assessed in ten patients with unstable angina (UA), 14 with acute myocardial infarction (AMI) and 14 age and sex macthed healthy subjects. Platelets homogenates western blot analysis were performed, in basal conditions and stimulated by SNP, to assess cGMP levels and the expression of the sGC isoforms. Upstream (Akt1 protein kinase α phosphorylation at Ser473 and eNOS phosphorylation) and downstream (vasodilatorstimulated phosphoprotein phosphorylation) signalling of the NO/cGMP pathway was tested in the three study groups. Results. Platelet activation, inflammation, thrombotic state and plaque disruption markers proved significantly higher in both the UA and AMI patients compared to healthy controls. Basal levels of cGMP (pmol/1010 platelets) were higher in platelets from UA (1097±111, p<0.0001) and AMI (1122±77, p<0.0001) patients compared to those from healthy controls (497±80). Similarly, serine phosphorylation in several proteins of the NO/cGMP signalling pathway (Akt1 protein kinase, NO synthase and VASP) was more represented in platelets from UA and AMI patients compared to controls. Following SNP stimulation AMI platelets disclosed a lack of cGMP increase and of VASP phosphorilation in comparison with healthy controls. Conclusion. The present study supports the hypothesis that low concentrations of endogenously synthesized NO and cGMP may promote platelet activation. The increased inflammatory state which often accompanies an acute coronary syndrome may be responsible of the platelet activation via the NO/cGMP pathway. Furthermore, platelets from AMI patients seem more resistant to SNP stimulation, exerted not only at the cGMP level but also at other signalling check-points.