A 55-year-old man has JAK2 V617F mutation, splenomegaly, and hemoglobin 20.5 g/dL, hematocrit 63%. He is at high risk for thrombosis (age >60). Which agent reduces thrombotic risk AND controls erythrocytosis in this polycythemia vera patient?
- A Phlebotomy alone
- B Ruxolitinib monotherapy
- C Hydroxyurea plus low-dose aspirin ✓
- D Interferon-alpha alone
Correct answer: C. Hydroxyurea plus low-dose aspirin
Explanation
In high-risk polycythemia vera (age >60 or prior thrombosis), cytoreductive therapy with hydroxyurea plus phlebotomy (to maintain hematocrit <45%) plus low-dose aspirin is the standard of care. This combination reduces the risk of cardiovascular events significantly (ECLAP trial showed aspirin reduces thrombosis by 60% in PV). Phlebotomy alone is adequate for low-risk patients. Ruxolitinib is used for hydroxyurea-resistant or intolerant PV. Interferon-alpha is an alternative particularly in younger or pregnant patients.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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