Aspirin is a common preventative therapy in patients at risk for cardiovascular diseases, yet little is known about how aspirin protects the vasculature in hypercholesterolemia. The present study determines whether aspirin, nitric oxide-releasing aspirin (NCX-4016), a selective cyclooxygenase (COX)-1 inhibitor (SC560), or genetic deficiency of COX-1 prevents the inflammatory and prothrombogenic phenotype assumed by hypercholesterolemic (HC) venules. Aspirin or NCX-4016 (60 mg/kg) was administered orally for the last week of a 2-wk HC diet. COX-1-deficient (COX-1 Ϫ/Ϫ ) and wild-type (WT) mice were transplanted with WT (WT/COX-1 Ϫ/Ϫ ) or COX-1 Ϫ/Ϫ (COX-1 Ϫ/Ϫ /WT) bone marrow, respectively. HC-induced adhesion of platelets and leukocytes in murine intestinal venules, observed with intravital fluorescence microscopy, was greatly attenuated in aspirin-treated mice. Adhesion of aspirin-treated platelets in HC venules was comparable to untreated platelets, whereas adhesion of SC560-treated platelets was significantly attenuated. HC-induced leukocyte and platelet adhesion in COX-1 Ϫ/Ϫ /WT chimeras was comparable to that in SC560-treated mice, whereas the largest reductions in blood cell adhesion were in WT/COX-1 Ϫ/Ϫ chimeras. NCX-4016 treatment of platelet recipients or donors attenuated leukocyte and platelet adhesion independent of platelet COX-1 inhibition. Platelet-and endothelial cell-associated COX-1 promote microvascular inflammation and thrombogenesis during hypercholesterolemia, yet nitric oxide-releasing aspirin directly inhibits platelets independent of COX-1. aspirin; NCX-4016; platelets; leukocytes; cyclooxygenase ASPIRIN THERAPY IS WIDELY used in patients at risk of developing atherosclerosis and thrombosis. The therapeutic efficacy of aspirin in cardiovascular diseases (CVD) is attributed to its platelet-inhibitory function, which results from irreversible inhibition of cyclooxygenase (COX) activity and thromboxane (Tx) generation (2, 33). Although platelets are a rich source of the constitutive isoform of COX (COX-1), endothelial cells also express COX-1 in addition to the inducible isoform, COX-2. This likely accounts for evidence implicating endothelial cell COX-1 inhibition in the beneficial effects of aspirin (but not COX-2 inhibitors) on the inflammation associated with atherosclerotic lesions in apolipoprotein E-deficient and lowdensity lipoprotein receptor-deficient mice (8,25). While the anti-inflammatory action of aspirin in this setting may also result from platelet inhibition (8), nonsteroidal anti-inflammatory drugs (NSAIDs) and their metabolites (i.e., salicylate) can directly interfere with adhesion of inflammatory cells to vascular endothelium, both in vitro (5, 11) and in vivo (1, 6). Hypercholesterolemia, diabetes, hypertension, and other risk factors for CVD promote inflammatory and thrombogenic responses in lesion-prone arteries. Similar responses are detected in microvasculature before the development of atherosclerotic lesions and may render tissues even more vulnerable to ischemic t...