Platelets play a critical role in the pathophysiology of acute coronary syndrome and thromboembolic complications associated with atrial fibrillation. Despite the development of newer and more potent antiplatelet agents, aspirin remains the cornerstone of antithrombotic therapy. Clinical trials conducted over the past decades have clearly established the safety and efficacy of aspirin therapy for the acute treatment and secondary prevention of acute myocardial infarction, ischemic stroke, and vascular death among patients at high risk for cardiovascular events. Although the absolute benefit of aspirin for primary prevention is lower than seen in secondary prevention trials, it is nevertheless an accepted preventive. This chapter provides a comprehensive overview of the clinical utility of aspirin in the setting of acute coronary syndrome and atrial fibrillation.
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