Table 2.

Recommendations for management of patients with polycythemia vera (PV).

aAvoid aspirin while platelet count > 1500 x 109/L. 
bAnagrelide plus venesection may be useful in patients intolerant of or resistant to hydroxyurea and interferon. 
cConsider 32P or intermittent use of busulfan if patient is very elderly and outpatient attendance is impractical. 

  1. Venesection to maintain hematocrit < 0.45

  2. Low-dose aspirin (unless contraindicated)a

  3. Manage reversible thrombotic risk factors aggressively (e.g., smoking, hypertension, hypercholesterolemia, obesity)

  4. Consider cytoreduction if

    • patient intolerant of venesection

    • thrombocytosis develops

    • symptomatic or progressive splenomegaly

  5. Choice of cytoreductive therapy:

    • < 40 years – interferon-αb

    • > 40 years – hydroxyureab,c

 
aAvoid aspirin while platelet count > 1500 x 109/L. 
bAnagrelide plus venesection may be useful in patients intolerant of or resistant to hydroxyurea and interferon. 
cConsider 32P or intermittent use of busulfan if patient is very elderly and outpatient attendance is impractical. 

  1. Venesection to maintain hematocrit < 0.45

  2. Low-dose aspirin (unless contraindicated)a

  3. Manage reversible thrombotic risk factors aggressively (e.g., smoking, hypertension, hypercholesterolemia, obesity)

  4. Consider cytoreduction if

    • patient intolerant of venesection

    • thrombocytosis develops

    • symptomatic or progressive splenomegaly

  5. Choice of cytoreductive therapy:

    • < 40 years – interferon-αb

    • > 40 years – hydroxyureab,c

 
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