From the Guidelines
Treatment for thrombocytosis is primarily focused on reducing the risk of thrombotic complications and managing symptoms.
First-line Therapy
- The first-line therapy for thrombocytosis, particularly in high-risk patients, is hydroxyurea, which has been shown to lower thrombotic complications compared to no treatment 1.
- Aspirin is also recommended for patients with microvascular disturbances, and its use should be considered in patients with cardiovascular risk factors or those who are JAK2 mutated 1.
Cytoreductive Therapy
- Cytoreductive therapy is indicated in high-risk patients, with hydroxyurea being the first-line cytoreductive therapy at any age 1.
- In young patients (< 40 years old), the use of hydroxyurea should be carefully considered due to potential long-term effects 1.
Management of Symptomatic Thrombocytosis
- For symptomatic thrombocytosis, treatment options include hydroxyurea, antiaggregants, anagrelide, or apheresis 1.
- 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 1.
General Management
- All patients should be managed aggressively for their cardiovascular risk factors and advised to stop smoking 1.
- Platelet count greater than 1,500 x 10^9/L is a risk factor for bleeding, and at this level of thrombocytosis, a platelet-lowering treatment should be considered 1.
From the Research
Treatment Options for Thrombocytosis
The treatment for thrombocytosis depends on the underlying cause and the patient's risk factors. Some studies suggest that antiplatelet therapy may be beneficial in certain cases of thrombocytosis 2.
Antiplatelet Therapy
- Acetyl-salicylic acid has been shown to be beneficial in patients with polycythaemia vera 2.
- Antiplatelet treatment may also be beneficial for patients with thrombocytosis in the context of chronic inflammation, malignancy, or exposure to high altitude 2.
- Low-dose aspirin (40 to 325 mg) can be used for patients whose platelet counts are < 1,500 x10(9)/L 3.
Cytoreductive Therapy
- Hydroxyurea is a common cytoreductive therapy used to treat essential thrombocythaemia and polycythemia vera 3.
- Anagrelide and interferon-alpha (IFN-alpha) are alternative cytoreductive therapies that can be used if hydroxyurea is not tolerated 3.
- Cytoreductive therapy is typically recommended for high-risk patients, including those with a history of thrombosis or advanced age 4, 3.
Risk Stratification
- Patients with essential thrombocythaemia can be stratified into low-risk, intermediate-risk, and high-risk categories based on their age, platelet count, and history of thrombosis 4, 5, 3.
- Low-risk patients may not require cytoreductive therapy, while high-risk patients typically require more aggressive treatment 5, 3.
- Intermediate-risk patients may require cytoreductive therapy or close monitoring, depending on their individual risk factors 3.