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Background: Acute type A aortic dissection (ATAAD) is life‐threatening and requires immediate surgery. Sudden chest pain may lead to a risk of misdiagnosis as an acute coronary syndrome and may lead to subsequent antiplatelet therapy (APT). We used the Chinese Acute Aortic Syndrome (AAS) Collaboration Database to study the effects of APT on clinical outcomes. Methods: The AAS database is a retrospective multicentre database where 31 of 3092 patients had APT with aspirin or clopidogrel or both before surgery. Before and after propensity score matching (PSM), the incidence of complications and mortality was compared between APT and non‐APT patients by using a logistic regression model. The sample remaining after PSM was 30 in the APT group and 80 in the non‐APT group. Results: The sample remaining after matching was 30 in the APT group and 80 in the non‐APT group. We found 10 cases with percutaneous coronary intervention in the APT group (33.3%). The APT group received more volume of packed red blood cells, 8.4 ± 6.05 units; plasma, 401.67 ± 727 ml, and platelet transfusion (14.07 ± 8.92 units). The drainage volume was much more in the APT group (5009.37 ± 2131.44 ml, p =.004). Mortality was higher in APT group (26% vs. 10%, p =.027). The preoperative APT was an independent predictor of mortality (odds ratio: 6.808, 95% confidence interval: 1.554–29.828, p =.011). Conclusion: APT before ATAAD repair was associated with more transfusions and higher early mortality. The timing of surgery should be carefully considered based on the patient's status and the surgeon's experience. Highlights: Whether preoperative antiplatelet therapy will affect the survival of patients with acute type A aortic dissection is still controversial.We conducted a retrospective analysis from the largest Chinese database.We provide new evidence to address this problem. [ABSTRACT FROM AUTHOR]