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Answer 4
  1. Phlebotomy and low-dose aspirin. The mainstay of therapy for polycythemia rubra vera is regular phlebotomy to keep the hematocrit below approximately 45%. This intervention will alleviate symptoms related to increased viscosity. A randomized study has shown the addition of 100 mg/d of aspirin significantly reduces the risk of developing thrombotic and cardiovascular events in polycythemia vera patients.4 Higher doses of aspirin in this patient group have been associated with an unacceptably high frequency of gastrointestinal bleeding. Because neither splenomegaly nor thrombocytosis are problematic at present, hydroxyurea therapy is not warranted.

    4. Landolfi R, Marchioli R, Kutti J, et al. Efficacy and safety of low-dose aspirin in polycythemia vera. N Engl J Med 2004;350:114-24.

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