NCCN Guidelines for Patients® | Myeloproliferative Neoplasms

35 NCCN Guidelines for Patients ® : Myeloproliferative Neoplasms, 2018 4 Polycythemia vera Initial treatment Aspirin Most people with PV receive aspirin. It is advised for both risk groups. Your doctor may not prescribe aspirin if you have had major bleeding. Aspirin increases the likelihood of bleeding. Aspirin should be withheld 1 week prior to any surgery. Aspirin for PV is prescribed at a low dose. A low dose consists of 80 to 100 milligrams a day. Higher doses should be avoided. High doses increase the chance of bleeding in your bowels. Aspirin has many health benefits. These benefits are described next. Smoking blocks the action of aspirin. You’ll have to quit smoking for aspirin to work. Vascular symptoms Low-dose aspirin is used to relieve vascular symptoms. These symptoms include headaches, dizziness, fainting, and chest pain. There may be abnormal changes in your vision like blind spots. You may also feel “pins and needles” in parts of your body (paresthesia). Vascular symptoms may include changes in your skin. Your legs or hands may turn red and have a painful, burning sensation. This is called erythromelalgia. A red or purplish net-like pattern may appear on your skin. This is called livedo reticularis. Aspirin may help prevent or relieve these skin problems. Other benefits Aspirin is advised to reduce vascular symptoms. However, it may have other benefits. It may prevent blood clots. It may reduce the likelihood of heart attacks and strokes. It may prevent death from cardiovascular causes. Pregnancy Taking aspirin during and shortly after pregnancy is advised. For a low-risk pregnancy, LMWH may be received instead of aspirin for 2 weeks before labor. For a high-risk pregnancy, you may take LMWH with aspirin throughout the pregnancy. Aspirin may be stopped 1 to 2 weeks before labor. LMWH should be stopped 12 to 24 hours before labor. After giving birth, restart treatment for 6 weeks. Surgery You may need surgery while being treated for PV. If so, stop taking aspirin 1 week beforehand. You may restart 24 hours after surgery unless you have a bleeding risk. I find it very important to be in the care of a MPN specialist and a local hematologist, who work together on my behalf. – Eric Survivor, Polycythemia vera “

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