Antiplatelet Therapy

In the 1970s following the results of their 01 trial, the PVSG studied whether the addition of antiplatelet agents would reduce the excess thrombotic risk seen in patients treated with phlebotomy alone. This trial (PVSG-05) randomized patients to receive either 32P or phlebotomy and antiplatelet therapy (900 mg aspirin/day and 75 mg pipyridamole/day). However patients in the phlebotomy/antiplatelet arm did not show a reduced rate of thrombosis and yet exhibited a significant increase in the risk of major hemorrhage.

It has subsequently been shown in other patients with vascular disorders that lower doses of aspirin (75 to 325 mg) are equally effective in the prevention of vascular events, with doses throughout this range being equally effective prophylaxis and the lower doses being better tolerated.122 It therefore seems reasonable to give low-dose aspirin (75 mg) to most PV patients in the absence of overriding contraindications.

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