Table 5.
Primary and Secondary Prevention of Thrombotic Events in Polycythemia Vera
| Clinical Feature | Intervention |
|---|---|
| Primary prophylaxis | |
| All PV patients | ASA |
| Unless | |
| vWF activity <30% | Consider holding ASA |
| Platelet >1 million | Consider holding ASA |
| Ht ≥45% | Phlebotomy/cytoreduction to target Ht <45% |
| High-risk PV (age >60 years/past thrombosis) | Cytoreduction |
| Secondary prophylaxis | |
| All patients | Cytoreduction |
| Typical VTE | Consider indefinite VKA for most patients, ASA if not on VKA |
| Atypical VTE | Indefinite VKA and DOAC |
| Arterial thrombosis | ASA |
Notes: Adapted with permission from Springer Nature. Martin K. Risk factors for and management of MPN-associated bleeding and thrombosis. Curr Hematol Malig Rep. 2017;12(5):389–396.44
Abbreviations: ASA, acetylsalicylic acid; DOAC, direct oral anticoagulant; Ht, hematocrit; PV, polycythemia vera; VKA, vitamin K antagonists; VTE, venous thromboembolism; vWf, von Willebrand factor.