Background: The mainstay of acute and long-term Management of Acute coronary syndrome includes aspirin and a P2Y12 inhibitor, such as clopidogrel or ticagrelor. Aspirin is a drug that has proved its efficacy in the treatment of various diseases in last 120 years and has stood the test of time. The challenge posed today is the variability in response to anti-platelet therapy which has been documented by many studies. The prevalence of resistance to aspirin is around 5%-45% worldwide. Hence, a study was planned to evaluate the factors causing aspirin resistance among the patients of acute coronary syndromes who were receiving of aspirin as anti-platelet drug therapy in our setting. Methods: A cross sectional, observational study was conducted in a tertiary care rural hospital in central India. Patients of acute coronary syndrome or follow up cases of acute coronary syndrome, who were prescribed aspirin for at least 7 days as antiplatelet therapy, were included in the study. The aspirin resistance was documented in 46 (45.09%) patients by a test based on the plateletworks kit. The factors causing aspirin resistance were evaluated. Statistical analysis was done by using descriptive and inferential statistics using chi square test and z-test. The statistical software used in the analysis was graph pad prism 5.0 and SPSS 17.0.Results and conclusion: The patients receiving 150 mg of aspirin, hypertension, concurrent intake of beta-blockers or ARB, elevated level of LDL cholesterol had a trend to be more inclined towards aspirin responders while patients receiving 75 mg of aspirin, diabetes and addiction to tobacco or alcohol had a trend to be more aspirin resistant. Other parameters tested namely age, gender, BMI, Duration of treatment, smoking, concurrent intake of statins, calcium channel blockers, ACE inhibitors, diuretics or PPI, blood glucose level or cholesterol levels (except LDL) did not show any statistically significant difference among the aspirin responders or