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How Do I Manage My Risk for Clotting As I Age With Essential Thrombocythemia (ET)?

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Published on November 30, 2017

During this Ask the Expert segment, a community member with essential thrombocythemia (ET) wants to know about increased risk for clotting as they age and how to prevent blood clot with their condition. Dr. Abdulraheem Yacoub responds to the question and shares choices patients can make to enhance their overall health and well-being.

The Ask the Expert series is sponsored through an educational grant to the Patient Empowerment Network from Incyte Corporation.

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Transcript | How Do I Manage My Risk for Clotting As I Age With Essential Thrombocythemia (ET)?

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That's how you’ll get care that's most appropriate for you.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Andrew Schorr:

Here's a question we got in from a member of our community, Sandy.  Sandy says, I've been living with ET for over 30 years taking anagrelide (Agrylin) to manage for almost 20 years, and two years ago a DVT was found in my thigh.  I was switched to hydroxyurea (Hydrea) with aspirin.  I'm still worried about clotting, and since I'm now older does clotting seem to increase in an ET patient, and should I consider doing something else to address the possibility of clotting? 

Dr. Yacoub:

This is a very well demonstrated example of how these diseases affect individuals at different stages of their lives and in different ways.  So as patients grow older their cardiovascular risk including a clotting risk increase.  And we physicians draw an arbitrary line at age 60 where patients over age 60 are automatically at a higher risk of clotting, and that's when we start using some drugs to lower the platelet counts.  But the risk of clotting actually is a dynamic, and it's a moving risk, and it increases as the patient grows older and as also you acquire additional cardiovascular risk factors and clotting risk factors. 

For example, having diabetes or having hypertension or having sedentary life choices can also increase your clotting risk, and by addressing all of these risk factors individually you can also improve your chances.  For example, for this particular patient in addition to the medications she can use, she can also make some different lifestyle changes by taking charge of controlling her blood pressure, taking charge of controlling her blood sugars and her cholesterol levels.  If there's any smoking exposure she could try to minimize or eliminate that and also increase her physical activity.  So a lot of these individual efforts can improve or reduce her risk of clotting in addition to the medications. 

Now, in terms of the medications that we physicians prescribe for this, so for many years anagrelide had been one of the standard pillars of therapy, however with some of the key clinical trials there was some improvement of that risk by using hydroxyurea instead of anagrelide.  So hydroxyurea with aspirin remains superior or better to anagrelide with aspirin, and now that she has made that change that would improve her chances of not having a clot a second time. 

So if she continues to have clots despite being on hydroxyurea and aspirin, then the next level would be to use medications to thin the blood such as blood thinners like warfarin (Coumadin) and the other newer drugs.  But it's a dynamic process, and it's a risk that can be mitigated by personal choices and by optimizing general health in addition to the medications that we prescribe. 

So patients have the absolute power to impact this by their choices, and the most important risk intervention that patients can undergo to reduce the clotting risk is to be active and to be athletic or try to implement a form of exercise in their daily schedule which would reduce the clotting risk, along with all the medications that we physicians can prescribe. 

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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