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Answer 3
  1. Hydroxyurea and aspirin. Hydroxyurea is a well-tolerated oral agent used to control high platelet counts and splenomegaly in patients with ET and other myeloproliferative conditions. Using hydroxyurea to keep the platelet count below 600 × 103/µL in patients at high risk of thrombotic events has been shown to reduce the risk of thromboses substantially.3Aspirin alone will not reduce the platelet count. However, the addition of aspirin is appropriate in patients with platelet counts over 1000 × 103/µL and/or symptoms of a thrombotic event. Aspirin can also help alleviate symptoms of erythromelalgia, which is common in ET but is not present in this case. Anagrelide has been used as an alternative to hydroxyurea but may be less effective at preventing thrombotic complications and has been shown to have a less tolerable side-effect profile eg, headaches, palpitations, orthostatic symptoms). Interferon-alpha, although effective at controlling blood counts, is not nearly as well tolerated as hydroxyurea and also has the disadvantage of subcutaneous administration. Although imatinib has been shown to have some effect against other myeloproliferative conditions, its usefulness in ET is unproven.

    3. Cortelazzo S, Finazzi G, Ruggeri M, et al. Hydroxyurea for patients with essential thrombocythemia and a high risk of thrombosis. N Engl J Med 1995;332:1132-6.

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