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Semin Thromb Hemost 1997; 23(4): 371-377
DOI: 10.1055/s-2007-996111
Copyright © 1997 by Thieme Medical Publishers, Inc.

Aspirin in Essential Thrombocythemia: Status Quo and Quo Vadis

Martin Griesshammer* , Markus Bangerter* , Huub H.D.M. van Vliet† , Jan J. Michiels‡
  • *Department of Internal Medicine III (Hematology, Oncology, Clinical Immunology, and Infectious Diseases), University of Ulm, Ulm, Germany,
  • †Department of Hematology, Erasmus University Hospital Dijkzigt, Rotterdam, and
  • ‡Department of Clinical Hematology, University of Amsterdam, Amsterdam, and European Working Group on MPD, Goodheart Institute, Rotterdam, The Netherlands.
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Publication Date:
08 February 2008 (online)

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Abstract

Aspirin has a well established role in the prevention of arterial thrombosis. Discussion on the efficacy and safety of aspirin in the treatment and prophylaxis of thrombosis in essential thrombocythemia (ET) has become an important issue. The rationale for its use in ET comes from the observation that arterial thrombosis and platelet-mediated microcirculatory disturbances are the major causes of morbidity and mortality in ET. Experimental data have shown persistently elevated levels of thromboxane A2 (TXA2) in ET patients probably reflecting an enhanced in vivo platelet activation. Increased TXA2 biosynthesis and platelet activation in vivo in ET are selectively suppressed by repeated low doses of aspirin. ET-related symptoms such as erythromelalgia, transient neurologic and ocular disturbances are sensitive to aspirin. However, the benefit of low-dose aspirin is still uncertain in the primary prevention of thrombosis in ET. Furthermore, aspirin may unmask a latent bleeding diathesis frequently present in ET which may result in severe hemorrhagic complications. Thus, aspirin is contraindicated in ET patients with a bleeding history or a very high platelet count (>1500 × 109/L) leading to the acquisition of von Willebrand factor deficiency. If indicated, aspirin is presently used in the widely accepted lowdose regimen of 100 mg daily. However, an optimal effective dose has not yet been established. To further evaluate the efficacy and safety of aspirin in ET, prospective clinical trials are needed.

Keywords:

Essential thrombocythemia - aspirin - treatment - arterial thrombosis - erythromelalgia - transient ischemic attacks (TIAs)