Patients with essential thrombo-cythemia have a high risk of thrombosis, particularly in the arteries. Hydroxyurea, often with low-dose aspirin, is widely used to control platelet counts in these patients. However, anagrelide (Agrylin®, Shire), which inhibits platelet aggregation, is also used in first-line therapy, despite drawbacks such as greater expense and concerns about efficacy.
A trial from the United Kingdom compared hydroxyurea plus aspirin with anagrelide plus aspirin in 809 high-risk patients for 12 to 72 months. The results give hydroxyurea/aspirin a distinct edge.
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The anagrelide/aspirin combination was associated with higher rates of arterial thrombosis, hemorrhage, transformation to myelofibrosis, and withdrawal from treatment. Although this therapy also carried a significantly lower rate of venous thromboembolism, the investigators were unsure whether anagrelide reduced the incidence or whether hydroxyurea raised it. They suggest that the optimal treatment of patients with previous venous thrombosis will depend on individual circumstances, but they note that arterial thrombosis is more than three times more common than venous thrombosis in essential thrombo-cythemia.
Both groups of patients maintained control of platelet counts.