Essential thrombocythemia: When is drug therapy necessary?

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Essential thrombocythemia: When is drug therapy necessary?

Question

My wife has essential thrombocythemia. Recently, her platelet count increased to 1.15 million platelets per microliter of blood. She currently takes 81 milligrams of aspirin daily. When her platelet count is so high, would she benefit from platelet-lowering medication or from a higher dose of aspirin?

Sanjay
No state given

Answer

Essential thrombocythemia refers to a high platelet count for which no cause can be determined. A normal platelet count ranges from 150,000 to 450,000 platelets per microliter.

Treatment of essential thrombocythemia depends on the individual's risk of a blood clot or bleeding episode. Not everyone who has essential thrombocythemia requires treatment with platelet-lowering medications. But those who may benefit from platelet-lowering medications — such as hydroxyurea, interferon alpha or anagrelide — include:

  • Individuals who are older than age 60
  • Individuals who have had a previous blood clot or bleeding episode
  • Individuals who are younger than age 60 and have not had a previous blood clot or bleeding but have risk factors for cardiovascular disease, such as prior heart attack or stroke, or high cholesterol
  • Individuals with a platelet count greater than 1.5 million platelets per microliter

The choice of which medication to use is complex and based on various factors, such as side effects, potential risks and cost. The most solid data from randomized trials suggest that hydroxyurea is the best first-line therapy for those requiring treatment. However, there are many reasons why one of the other medications may need to be considered. It is important to discuss this with a doctor who is familiar with essential thrombocythemia before considering a treatment.

Low-dose aspirin lowers the risk of blood clots in individuals with essential thrombocythemia but has no effect on platelet count.

Last Updated: 11/03/2006
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