From the Guidelines
Thrombocytosis with a platelet count of 1146 should not be treated unless the patient has symptoms or risk factors for thrombosis. The management of thrombocytosis depends on the underlying cause and the presence of risk factors for thrombosis. According to the NCCN guidelines 1, asymptomatic patients with very low-risk or low-risk essential thrombocythemia do not require cytoreductive therapy. The guidelines recommend monitoring for new thrombosis, acquired von Willebrand disease, and/or disease-related major bleeding, as well as managing cardiovascular risk factors. Low-dose aspirin (81-100 mg daily) may be prescribed for patients with vascular symptoms or those who are at high risk of thrombosis. However, cytoreductive therapy may be necessary for patients with symptomatic thrombocytosis, progressive leukocytosis, or disease-related symptoms. A more recent study 1 suggests that aspirin may not be beneficial in patients with low-risk CALR-mutated ET, but the evidence is not yet sufficient to recommend withholding aspirin in this group. In patients with extreme thrombocytosis (platelet count over 1 million/μL), acquired von Willebrand syndrome should be ruled out, and aspirin should be avoided if present. Some key points to consider in the management of thrombocytosis include:
- Monitoring for thrombotic complications and bleeding risk
- Managing cardiovascular risk factors
- Using low-dose aspirin for patients with vascular symptoms or high-risk features
- Considering cytoreductive therapy for patients with symptomatic thrombocytosis or high-risk features
- Avoiding aspirin in patients with extreme thrombocytosis and acquired von Willebrand syndrome. It is essential to individualize treatment based on the patient's specific risk factors and symptoms, and to prioritize minimizing bleeding risk while preventing thrombotic complications.
From the Research
Thrombocytosis Treatment
The user's question about whether a platelet count of 1146 should be treated can be addressed by considering the condition of thrombocytosis. Thrombocytosis is characterized by an elevated platelet count, which can be either primary (essential thrombocythemia) or secondary (reactive thrombocytosis) 2.
Essential Thrombocythemia
Essential thrombocythemia is a myeloproliferative neoplasm that can lead to thrombotic and hemorrhagic complications. Studies have shown that cytoreductive drugs, such as hydroxyurea, can lower the incidence of bleeding and thrombotic episodes in patients with essential thrombocythemia 3, 4. Anagrelide is another option for patients who are intolerant or resistant to hydroxyurea 3, 5.
Treatment Options
Treatment options for essential thrombocythemia include:
- Hydroxyurea as a first-line treatment to reduce platelet count and prevent thrombotic complications 4
- Anagrelide as a second-line treatment for patients who are intolerant or resistant to hydroxyurea 3, 5
- Interferon-alpha as an alternative treatment option 5, 6
- Low-dose aspirin for patients with platelet counts < 1,500 x 10^9/L 5
Risk Assessment
The decision to treat thrombocytosis depends on the patient's risk category, which is determined by factors such as age, prior thrombosis, and cardiovascular risk factors 5. High-risk patients, such as those over 60 years old or with a history of thrombosis, require treatment to prevent thrombotic complications.