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Treatments and drugs
By Mayo Clinic staffTreatment of essential thrombocythemia depends on your risk of blood-clotting or bleeding episodes. If you're younger than 60, have had no signs or symptoms and have no other risk factors for developing blood clots, such as smoking, you may simply need periodic medical checkups. If you're older than 60 and have had previous signs and symptoms of blood clots, your doctor likely will prescribe medication or a medical procedure to lower your platelet count. Your doctor may also recommend treatment if you have cardiovascular risk factors, such as high cholesterol, high blood pressure or diabetes.
Medication
If you're at risk of blood clots, your doctor may recommend low-dose aspirin, particularly if you're pregnant. Aspirin makes the platelets less sticky and your blood less likely to form clots. If you take aspirin during pregnancy, stop taking it at least one week before delivery to lower your risk of bleeding complications during delivery.
Drugs that reduce the platelet count and are commonly used to treat ET include:
- Hydroxyurea (Droxia, Hydrea). This drug suppresses bone marrow production of blood cells, including platelets. Also used to treat cancers, it's the most commonly prescribed platelet-lowering drug for ET. It's often used in combination with low-dose aspirin. If you take hydroxyurea, your doctor will monitor your blood counts closely. There's some concern that long-term use may increase the risk of developing acute myelogenous leukemia.
- Anagrelide (Agrylin). Unlike hydroxyurea, anagrelide isn't associated with an increased risk of leukemia. But it's not considered as effective as hydroxyurea. Side effects may include fluid retention, heart problems, headaches, dizziness, nausea and diarrhea.
- Interferon alfa-2B (Intron A). Given by injection, this drug is less convenient to administer than hydroxyurea or anagrelide, may be more expensive and may cause less tolerable side effects. Side effects may include flu-like symptoms, confusion, nausea, depression, diarrhea, seizures, irritability and sleepiness.
Plateletpheresis
Used only in emergencies, such as after a stroke or other dangerous blood clotting, a medical procedure known as plateletpheresis can be used to rapidly lower platelet count. During the procedure, an intravenous (IV) needle connected to a tube is inserted into one of your blood vessels. Your blood flows through the tube and into a device that removes platelets from your blood. The remaining portion of your blood (plasma) and your red cells are then returned to you through an IV line. The effect is temporary.
- Thrombocythemia. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merck.com/mmpe/print/sec14/ch178/ch178d.html. Accessed June 12, 2010.
- Tefferi A. Diagnosis and clinical manifestations of essential thrombocythemia. http://www.uptodate.com/home/index.html. Accessed June 12, 2010.
- What are thrombocythemia and thrombocytosis? National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/dci/Diseases/thrm/thrm_all.html. Accessed June 12, 2010.
- Tefferi A. Myeloproliferative disorders: Essential thrombocythemia and primary myeolfibrosis. In: Goldman L, et al, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2008. http://www.mdconsult.com/das/book/body/206064361-4/1014199238/1492/658.html#4-u1.0-B978-1-4160-2805-5..50182-8--cesec8_7943. Accessed June 12, 2010.
- Essential or primary thrombocythemia. The Leukemia & Lymphoma Society. http://www.leukemia-lymphoma.org/attachments/National/br_1178803674.pdf. Accessed June 12, 2010.
- Chronic myeloproliferative disorders treatment (PDQ): Patient version. National Cancer Institute. http://www.cancer.gov/cancertopics/pdq/treatment/myeloproliferative/patient/allpages/print. Accessed June 12, 2010.
- Vannucchi A, et al. Advances in understanding and management of myeoloproliferative neoplasms. CA: A Cancer Journal for Clinicians. 2009;59:171.
- Finazzi G, et al. Essential thrombocythemia. In: Hoffman R, et al. Hematology: Basic Principles and Practice. 5th ed. Philadelphia, Pa: Churchill Livingstone Elsevier; 2009. http://www.mdconsult.com/book/player/book.do?method=display&type=bookPage&decorator=header&eid=4-u1.0-B978-0-443-06715-0..50073-X&uniq=206064361&isbn=978-0-443-06715-0&sid=1014199238. Accessed June 17, 2010.
- Tefferi A. Prognosis and treatment of essential thrombocythemia. http://www.uptodate.com/home/index.html. Accessed June 12, 2010.
- Myeloproliferative disorders. Lab Tests Online. http://www.labtestsonline.org/understanding/conditions/myelopro_disorders-3.html#. Accessed June 17, 2010.
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