Acute occlusion of the coronary artery by the plaque + superimposed thrombus complex results in acute imbalance in myocardial oxygen demand and supply which, when prolonged and unabated, leads to myocardial cell necrosis and infarction. Aspirin inhibits the formation of thromboxane A2, a potent stimulator of platelet aggregation, and is the first-line therapy for AMI.30 Following an initial loading dose of 162 to 325 mg of non enteric-coated aspirin, an 81-mg daily dose is preferred to higher doses to minimize bleeding risk.31 34 Aspirin should be continued indefinitely after a MI.46 The Antithrombotic Trialists Collaboration s meta-analyses firmly confirmed the benefits of long-term aspirin therapy in patients at high-risk of occlusive vascular events, including patients with prior or acute MI.32 A subsequent meta-analysis inclusive of 16 secondary prevention trials (n=17000 patients) compared long-term aspirin versus control and demonstrated that aspirin allocation was associated with a 1.5% significantly lower risk of serious vascular events per year, as well as significant reductions in coronary events and total stroke events.39 Clinical Recommendation(s) 2013 ACCF/AHA Guideline for the Management of Patients With ST-Elevation Myocardial Infarction12 1. After PCI, aspirin should be continued indefinitely.13,32,47 (Class I, Level of Evidence: A) 2. Aspirin should be continued indefinitely30,37,38 (Class I, Level of Evidence: A), and clopidogrel (75 mg daily) should be continued for at least 14 days37,38 (Class I, Level of Evidence: A) and up to 1 year (Class I, Level of Evidence: C) in patients with STEMI who receive fibrinolytic therapy. 2014 AHA/ACC Guideline for the Management of Patients With Non ST-Elevation Acute Coronary Syndromes11 1. After PCI, aspirin should be continued indefinitely at a dose of 81 mg to 325 mg daily.13,39,47 (Class I, Level of Evidence: B) 2. Aspirin should be continued indefinitely. 