From the Guidelines
Aspirin is started in all polycythemia vera (PV) patients with JAK2 mutation who have no contraindication to aspirin therapy.
Rationale
- The use of low-dose aspirin in PV patients has been shown to reduce the risk of thrombotic complications, as demonstrated in the ECLAP study, which found a significant reduction (60%) in the combined risk of nonfatal myocardial infarction, nonfatal stroke, pulmonary embolism, major venous thrombosis, or death from cardiovascular causes 1.
- The ECLAP study, a large European double-blind, placebo-controlled, randomized trial, also showed that low-dose aspirin safely reduced the risk of the combined endpoint of nonfatal myocardial infarction, nonfatal stroke, or death from cardiovascular causes (RR, 0.41; 95% CI, 0.15–1.15; P=0.09) and the risk of the combined endpoint of nonfatal myocardial infarction, nonfatal stroke, pulmonary embolism, major venous thrombosis, or death from cardiovascular causes (RR, 0.40; 95% CI, 0.18–0.91; P=0.03) 1.
- Additionally, maintaining a hematocrit level <45% has been shown to lower the risk of thrombosis in PV patients, as demonstrated in the CYTO-PV trial, which found that targeting a hematocrit level <45% significantly reduced the composite primary endpoint of time until death from cardiovascular causes or major thrombotic events (HR in the high hematocrit group, 3.91; 95% CI, 1.45–10.53; P=0.007) 1.
- Low-dose aspirin is considered a cornerstone of PV therapy, and its use is recommended in patients with no contraindication to aspirin therapy, as stated in the ESMO clinical practice guidelines 1.
- Key points to consider when starting aspirin in PV patients include:
- No contraindication to aspirin therapy
- No history of a thrombotic event
- Hematocrit level <45%
- Use of cytoreductive drugs, such as hydroxyurea, in high-risk patients
- Consideration of alternative treatments, such as IFN-α, in young subjects or those previously treated with other myelosuppressive agents 1.
The FDA Drug Labels for aspirin (PO) do not address this question.
From the Research
Aspirin Therapy in Polycythemia Vera (PV) Patients with JAK2 Mutation
- All patients with PV, including those with a JAK2 mutation, should receive low-dose aspirin therapy, unless there are contraindications 2, 3, 4, 5.
- The use of aspirin in PV patients is aimed at preventing thrombohemorrhagic complications, which is a major goal of therapy in this disease 2, 3.
- Low-dose aspirin (81 mg) is recommended for all PV patients, including those with a JAK2 mutation, as part of the initial treatment strategy 2, 3, 4.
- Some studies suggest that twice-daily aspirin dosing may be considered, but controlled studies are needed to confirm the clinical outcome value of this approach 3.
- The presence of a JAK2 mutation is a key diagnostic criterion for PV, and aspirin therapy is a standard part of the treatment regimen for these patients 2, 3, 4, 5.