Opinion|Videos|April 28, 2025
Cardiovascular Risk Assessment: Stratification and Management Implications in PV
Panelists discuss how thrombotic risk assessment—anchored in age, thrombotic history, and additional factors like leukocytosis and JAK2 allele burden—guides personalized therapy in polycythemia vera (PV), balancing cytoreduction, symptom control, and prevention of vascular events.
Episodes in this series
Summary for Physicians: Thrombotic Risk Assessment in PV and Its Role in Guiding Therapy
Thrombotic risk assessment is a critical component of therapeutic decision-making in polycythemia vera (PV), as thrombotic events are a leading cause of morbidity and mortality in this disease. Risk stratification is primarily based on clinical factors, but additional markers can further inform treatment strategy.
Key Elements of Risk Assessment:
- Traditional Risk Factors:
- Age >60 years
- History of thrombotic events
These define the classic high-risk category and are used to guide the initiation of cytoreductive therapy.
- Additional Considerations:
- Persistent leukocytosis
- Cardiovascular comorbidities
- High JAK2 allele burden
These factors may influence therapeutic decisions, particularly in patients who fall outside of traditional high-risk definitions but may still carry elevated thrombotic risk.
Impact on Treatment Strategy:
- Low-Risk Patients (≤60 years, no thrombotic history): Managed with phlebotomy and low-dose aspirin, aiming to maintain hematocrit <45%.
- High-Risk Patients (>60 years and/or thrombotic history): Require cytoreductive therapy, typically starting with hydroxyurea. Interferons or JAK inhibitors may be considered based on tolerance, adverse effects, and disease features.
The approach emphasizes balancing thrombotic risk reduction with disease control and quality of life, using a tailored strategy based on individual patient characteristics.
