Which statement best describes the role of aspirin in acute coronary syndrome management?

• A. Aspirin should be given immediately as part of initial therapy
• B. Aspirin is contraindicated in ACS
• C. Aspirin has no effect on mortality
• D. Aspirin should be given only after reperfusion

Answer: (A)

In acute coronary syndrome, the immediate goal is to stop further platelet-driven clotting at the site of plaque rupture. Aspirin achieves this by irreversibly inhibiting COX-1 in platelets, which blocks thromboxane A2 production and markedly reduces platelet aggregation for the life of the platelet. Because this action is rapid and ongoing, giving aspirin right away as part of initial therapy lowers the risk of death and recurrent ischemia. A chewable non-enteric-coated dose in the 160–325 mg range is recommended at once to ensure fast onset, unless there is a specific contraindication. The benefit persists regardless of the chosen reperfusion strategy, and suggesting it has no effect on mortality or that it should wait until after reperfusion is inconsistent with evidence and guidelines.