This page addresses the treatment approach for essential thrombocythemia (ET) in a well-defined intermediate-risk scenario: patients older than 60, with no prior thrombotic events, JAK2 wild-type status, and cardiovascular risk factors present.
Risk stratification in ET starts with thrombosis history, JAK2 mutation status, and age. A patient over 60 years old with no thrombosis history and JAK2 wild-type falls into the intermediate-risk category. When cardiovascular risk factors are also present, the treatment selection within this group is specifically informed by that combination.
For intermediate-risk ET patients with cardiovascular risk factors, a cytoreductive drug in combination with aspirin represents the considered approach. The complete structured regimen — including the specific agents, sequencing, and clinical algorithm — is in the full protocol.
Full details available via the link below.
Platelet count maintained in the normal range.
DOI: 10.1002/ajh.27216
Figure 5 outlines our general treatment approach in ET, which starts with thrombosis risk stratification: very low (age ≤60 years, no thrombosis history, JAK2 wild-type), low (same as very low but JAK2 mutation present), intermediate (age >60 years, no thrombosis history, JAK2 wild-type), and high (thrombosis history present or age >60 years with JAK2 mutation).
Twice-daily aspirin is also our current treatment choice for intermediate-risk disease, but combination of a cytoreductive drug with once-daily aspirin is a reasonable alternative in intermediate-risk patients with CV risk factors (Figure 5).
The dose of HU is titrated to keep platelet count in the normal range.
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