From the Guidelines
The preferred treatment for thrombocytosis with a platelet count of 668 × 10^9/L is typically observation and addressing any underlying cause rather than specific platelet-lowering therapy. This level of thrombocytosis is considered mild to moderate and often doesn't require immediate pharmacological intervention if the patient is asymptomatic. The first step should be determining whether this is reactive thrombocytosis (secondary to infection, inflammation, iron deficiency, or other conditions) or essential thrombocythemia (a myeloproliferative neoplasm) 1. For reactive thrombocytosis, treating the underlying condition will usually normalize platelet counts. If the patient has risk factors for thrombosis such as advanced age, history of thrombotic events, cardiovascular risk factors, or symptoms, low-dose aspirin (81-100 mg daily) may be prescribed to reduce thrombotic risk 1. For essential thrombocythemia with this platelet count, risk stratification would determine treatment, but typically cytoreductive therapy like hydroxyurea would only be initiated for higher risk patients or those with counts consistently above 1,000 × 10^9/L 1. Some key considerations in management include:
- Monitoring for new thrombosis, acquired VWD, and/or disease-related major bleeding
- Managing cardiovascular risk factors
- Using aspirin (81–100 mg/d) for vascular symptoms or observation
- Initiating cytoreductive therapy for symptomatic thrombocytosis or progressive disease-related symptoms Regular monitoring of platelet counts and assessment for symptoms is important regardless of the treatment approach chosen 1.
From the FDA Drug Label
Anagrelide is a platelet reducing agent indicated for the treatment of thrombocythemia, secondary to myeloproliferative neoplasms, to reduce the elevated platelet count and the risk of thrombosis and to ameliorate associated symptoms including thrombo-hemorrhagic events. The preferred treatment intervention for a patient with a platelet count of 668, indicating thrombocytosis, would be to use a platelet reducing agent such as anagrelide to reduce the elevated platelet count and the risk of thrombosis 2.
- The goal of treatment is to reduce the platelet count to a normal range and prevent thrombo-hemorrhagic events.
- Anagrelide is specifically indicated for this purpose, making it a suitable choice for this patient 2.
From the Research
Treatment Options for Thrombocytosis
The patient's platelet count is 668, which is considered elevated. According to the studies, the preferred treatment intervention for thrombocytosis with a platelet count of 668 would depend on the risk category of the patient.
- Low-Risk Patients: For low-risk patients, low-dose aspirin (40 to 325 mg) can be used if the platelet count is < 1,500 x 10(9)/L 3.
- High-Risk Patients: For high-risk patients, hydroxyurea is the recommended treatment to reduce the risk of thrombosis 3, 4.
- Alternative Treatments: Other treatment options include anagrelide and interferon-alpha (IFN-alpha) for patients who cannot tolerate hydroxyurea or have contraindications to its use 3, 5, 6.
Aspirin Therapy
Aspirin is commonly used in the treatment of essential thrombocythemia to prevent thrombotic complications. The recommended dose of aspirin is 81-100 mg once daily, which irreversibly inhibits platelet thromboxane A2 (TxA2) production 7. However, some patients may require twice daily aspirin administration to achieve adequate inhibition of platelet TxA2 production.
Platelet Count and Treatment
The patient's platelet count of 668 is below the threshold of 1,500 x 10(9)/L, which is considered a low-risk category. Therefore, low-dose aspirin may be a suitable treatment option for this patient. However, the treatment plan should be individualized based on the patient's overall risk profile and medical history.