Asymptomatic patients do not usually require treatment. There is no evidence to support the reduction of platelet counts except where there is evidence of vaso-occlusive phenomena - for example, digital pain, transient ischaemic attacks. Aspirin in conjunction with a cytoreductive agent, such as hydroxyurea are then given.
Patients who wish an urgent reduction of the platelet counts can be treated with plasmapheresis. However, rebound thrombocytosis may occur once therapy is complete.
Anagrelide reduces platelet counts without increasing the risk of bleeding and is currently being investigated.
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