Background: Various strategies under investigation aim to improve the outcome of transarterial chemoembolization (TACE). Aspirin demonstrated chemopreventive, antithrombotic and anti- inflammatory properties. Moreover, it has been reported that aspirin may reverse apoptosis resistance in hepatocellular carcinoma (HCC) cell lines. Objective: To explore the clinical impact of adding aspirin with TACE in management of unresectable HCC patients. Patients and Methods: This prospective randomized trial included 60 cases diagnosed as HCC indicated for TACE; who were simply randomized into two arms with ratio 1:1; to control arm and aspirin arm. Aspirin arm patients received 75 mg of aspirin daily for 3 months; we assessed aspirin toxicity and disease outcome. Results: In this study most of side effects of aspirin were of grade I gastrointestinal side effect. 10% of patients in aspirin arm had complete response versus 6.7 % in control arm and 30% had partial response in aspirin arm versus 23% in control arm, 30% of patients in aspirin arm had disease progression versus 40% in control arm. The median progression free survival and Overall survival were not reached for aspirin arm versus 11 and 22 months for control arm (P=0.035 and P=0.036 respectively). Conclusions: Low dose aspirin use in selected unresectable intermediate stage HCC undergoing TACE is tolerable and could be associated with survival benefit.