Editing Essential thrombocythemia (section)

==Treatment==

===Indications===
Not all those affected will require treatment at presentation.<ref name="man1">{{cite journal |last=Cervantes |first=F |s2cid=18862829 |title= Management of Essential Thrombocythemia|journal=Hematology |date=2011 |volume=2011 |pages=215–21 |doi=10.1182/asheducation-2011.1.215 |pmid=22160037 |doi-access=free }}</ref><ref name="man2">{{cite journal |last=Birgegård |first=G |s2cid=11357000 |title=Pharmacological management of essential thrombocythemia. |journal=Expert Opinion on Pharmacotherapy |date=July 2013 |volume=14 |issue=10 |pages=1295–306 |doi=10.1517/14656566.2013.797408 |pmid=23668666}}</ref><ref name="man3">{{cite journal |last1=Tefferi |first1=A |last2=Barbui |first2=T |title=Personalized management of essential thrombocythemia-application of recent evidence to clinical practice. |journal=Leukemia |date=August 2013 |volume=27 |issue=8 |pages=1617–20 |doi=10.1038/leu.2013.99 |pmid=23558521 |pmc=3740400}}</ref> Patients are usually designated as having a low or high risk of bleeding or developing blood clots based on their age, medical history, blood counts and their lifestyles. Low risk individuals are usually treated with [[aspirin]], whereas those at high risk are treated with [[hydroxycarbamide]], [[interferon-α]] or [[anagrelide]].<ref name="path" /><ref name="man1" /><ref name="man2" /><ref name="man3" /> Currently unapproved but in late-stage clinical trials (NCT04254978) are agents that lower platelets such as [[bomedemstat]].

===Agents===
[[Hydroxycarbamide]], [[interferon-α]] and [[anagrelide]] can lower the platelet count. Low-dose aspirin is used to reduce the risk of blood clot formation unless the platelet count is very high, where there is a risk of bleeding from the disease, and hence this measure would be counter-productive as aspirin-use increases the risk of bleeding.<ref name="path" /><ref name="man1" /><ref name="man2" /><ref name="man3" />

The PT1 study compared hydroxyurea plus aspirin to anagrelide plus aspirin as initial therapy for ET.  Hydroxyurea treated patients had a lower incidence of arterial thrombosis, lower incidence of severe bleeding and lower incidence of transformation to myelofibrosis, but the risk of venous thrombosis was higher with hydroxycarbamide than with anagrelide. It is unknown whether the results are applicable to all ET patients.<ref name="path" /><ref name="man1" /><ref name="man2"/><ref name="man3"/> In people with symptomatic ET and extremely high platelet counts (exceeding 1 million), [[plateletpheresis]] can be used to remove platelets from the blood to reduce the risk of thrombosis.<ref>{{Cite journal|last1=Boddu|first1=Prajwal|last2=Falchi|first2=Lorenzo|last3=Hosing|first3=Chitra|last4=Newberry|first4=Kate|last5=Bose|first5=Prithviraj|last6=Verstovsek|first6=Srdan|date=2017-07-01|title=The role of thrombocytapheresis in the contemporary management of hyperthrombocytosis in myeloproliferative neoplasms: A case-based review|journal=Leukemia Research|language=en|volume=58|pages=14–22|doi=10.1016/j.leukres.2017.03.008|pmid=28380402 |pmc=5466892 |issn=0145-2126}}</ref>