In chronic ACS management, how long should aspirin be continued?

• A. 1 year
• B. Indefinitely
• C. 6 months
• D. 2 years

Answer: (B)

In chronic ACS management, aspirin is continued indefinitely because the risk of recurrent thrombotic events persists long term. Aspirin works by irreversibly inhibiting COX-1 in platelets, which lowers thromboxane A2 and reduces platelet aggregation. After an ACS event (and especially if a stent was placed), patients typically receive dual antiplatelet therapy for a finite period to protect against stent thrombosis, but once that initial period ends, aspirin is kept going for the long term as part of ongoing secondary prevention. Finite durations like six months, one year, or even a couple of years don’t provide ongoing protection against late recurrent events, whereas continuing aspirin indefinitely aligns with the persistent ischemic risk unless there are contraindications such as major bleeding.