Previous studies found that acute physical exertion may trigger an acute coronary syndrome. The relative risk of cardiac events was 2-6 times higher during strenuous physical exertion (>6 METs) compared with during mild to moderate intensity activities in cardiac patients.[4] One of the possible explanations for this is that acute physical exertion may acutely change the hemostatic milieu in favor of increased coagulation and activation of platelet.[5] Available evidence suggests that strenuous exercise, in both healthy subjects and in various cardiovascular disease states, is associated with activation of platelets and blood coagulation, leading to a prothrombotic or hypercoagulable state.[6, 7] Aspirin is ineffective in attenuating enhanced platelet aggregation and activation induced by exercise.[8]