Studies have demonstrated increased homologous blood product requirements in patients on aspirin (ASA) undergoing cardiac surgery. We reexamined the influence of ASA therapy on hemorrhage and transfusion requirements in patients undergoing elective coronary artery bypass (CAB) surgery in light of recent transfusion-sparing practices and autologous cell salvaging techniques. Records from 197 patients who underwent reinfusion of postoperatively shed mediastinal autologous whole blood were retrospectively reviewed, including 87 patients who received ASA within 1 wk prior to surgery and 110 control patients. Patients undergoing repeat cardiac operations were excluded from the study. Cardiopulmonary bypass (CPB) duration, procedure length, aortic cross-clamp time, and number of grafts performed did not differ significantly between groups. None of the patients required reexploration for bleeding. There was significantly more mediastinal tube drainage in the ASA group (27%), but it did not affect homologous blood component requirements because this blood was autotransfused. In addition, there were no significant differences in platelet, fresh frozen plasma, and cryoprecipitate use between the groups. Thus, ASA did increase bleeding but did not increase homologous blood transfusion requirements in elective CAB surgery.