How should I manage a patient with essential thrombocythaemia who presents with a history of recurrent thrombosis?

Management of a patient with essential thrombocythaemia (ET) and a history of recurrent thrombosis involves:

• Pharmacological cytoreductive therapy: This is recommended for patients at high risk of thrombosis, including those with any history of thrombosis. The first-line cytoreductive drug is usually hydroxycarbamide. Alternatives such as interferon alfa or ruxolitinib may be considered if hydroxycarbamide is contraindicated, not tolerated, or ineffective. In older patients or those with short life expectancy, busulfan may be used if other agents are not tolerated. Treatment is titrated to control platelet counts and reduce thrombotic risk ¹,².
• Antiplatelet therapy: Low-dose aspirin (75 mg daily) is generally prescribed unless contraindicated, to reduce thrombotic risk ¹,².
• Anticoagulation: For patients with recurrent thrombosis, especially venous thromboembolism, long-term anticoagulation should be considered following standard venous thromboembolism management guidelines, including assessment of anticoagulation adherence and adjustment if treatment failure occurs ³.
• Monitoring and supportive care: Regular monitoring of blood counts and symptoms is essential. Cytoreductive therapy may also be considered if white blood cell or platelet counts are abnormally high, thrombosis or bleeding occurs, or there is evidence of disease progression ¹,².
• Specialist referral: Management should be coordinated with haematology specialists experienced in myeloproliferative neoplasms to optimize therapy and monitor for complications.