Aspirin dose for ET update.

[Magentas]

I saw my awesome new haematologist yesterday and queried her about the prescribed twice daily aspirin, she cited this study below and confirmed ET patients should take it twice a day. (FYI, at the same appointment my diagnosis changed from ET to MF due to BMB results so I’m now only on one) ncbi.nlm.nih.gov/pmc/articl...

[Whitehair51]

Did your hematologist tell you where to find the results of this study? It looks like it was proposed in June of 2018. Are you low risk, i.e. under 65?

[Magentas in reply to Whitehair51]

She called it the “ARES” study. I’m afraid I only googled and posted the first one I came across, I haven’t read it myself yet. Maybe I went too soon, ugh.I’m 62, been a lifelong smoker until diagnosis, then quit, healthy otherwise. But as Hunter says I guess there’s no one size fits all but I figure some sizes are helpful if you don't have access to MPN specialists...especially U.S ones.

[MPNBlog in reply to Whitehair51]

Hi there. Here's a link to some of the findings from the ARES trial for the use of aspirin in ET [9 July 2020]A randomized double-blind trial of 3 aspirin regimens to optimize antiplatelet therapy in essential thrombocythemia | Blood | American Society of Hematology (ashpublications.org) Blood (2020) 136 (2): 171–182.

Key Points

◦ Most of the 245 patients with essential thrombocythemia who were treated with once-daily low-dose aspirin exhibit incomplete platelet inhibition.

◦ In this randomized study, platelet inhibition was improved by twice-daily dosing, with no further inhibition using a shorter interval.

[Magentas in reply to MPNBlog]

2020! there you go.. gives me more faith in my haematologist but it’s also dizzying as to what to wrap your head around. I guess partly its that studies are only just that and depending on how long they go for they can be quite inconclusive….

[MPNBlog in reply to Magentas]

There could be further results over time too. Hunter is right that it's about the short half-life of aspirin. So really, really low dose aspirin but administered 12 hourly seems one of the best solution for ET. UK has 75mg aspirin and USA 81 mg, but Australia's lowest is 100mg.

[Magentas in reply to MPNBlog]

Oh, I didn’t know the US dose was different as well.

I find that the oddest thing, that here we don’t conform to the UK dose or the US dose.

2x75 mg a day sounds comforting.

[hunter5582]

That has been reported from multiple sources. Has to do with the very short half-life of aspirin and its mechanism of action. However, like all things it is complicated. We do not all respond to aspirin the same. It is contraindicated for some people with thrombocytosis who are at elevated risk for hemorrhage. Aspirin also has to be used more cautiously at age>60 since our bodies react more strongly to it as we age (per my MPN specialist and others). Aspirin is not string enough for some people who need other forms of anti-thrombotic therapy (anti-platelet or anti-coagulant). And there are some people who cannot tolerate aspirin due to the adverse effects (e.g. GI effect).

It all goes back to why we need to consult with a MPN Specialist who looks at each case individually rather than just apply a generic protocol that may or may not apply to an individual case. Very glad to hear you have an "awesome new haematologist ." Good news!!

[Magentas in reply to hunter5582]

Thanks Hunter! 😊

[Amethist]

Just to add to the conversation, for discussion, not to say I am right or anything. I managed to see an MPN specialist ( from the world list of MPN specialists) for my second opinion last week.

As my platelets were above 1500 at the previous test, plus being JAK2 +, the topic of aspirin was discussed. (I am 53, female, slim, have never had any thrombosis, have no CVD risks, keep fit and eat as healthily as possible, have no other ET symptoms than very mild erythromelalgia in toes - which disappears for 3 days with a little aspirin, plus take some supplements. Apart from high platelets, all other bloods are within normal range.)

She explained how aspirin permanently deactivates the platelets through platelet cyclooxygenase inhibition. (Jan Jacques Michiels is the author of many papers on this topic and only retired very recently. You can look him up with his name + aspirin.)

She also went on to say that every day, your body replaces cells, and with platelets its about 10% a day. ( These new cells have NOT been deactivated)

I told her that for me, one aspirin every 3rd day works well. She pondered that for a bit, worked out the math’s for cell reproduction, and, whilst she would normally recommend daily, she did not see any real problem with what I was doing either, and was happy for me to continue. Maybe with high platelets, I guess its a bit of a balance between clotting and bleeding.

I have also read from others that their MPN specialists are also ok with every other day regimes, or even taking a break from aspirin.

Clearly all treatments must be individualized, and what works for one won’t suit another.

Thankfully, she also felt I was not a candidate for cytoreductive treatment either, ( as she said there is no correlation with platelet numbers and thrombosis - a statement repeated in many papers too), so I was very happy I saw her. (A more recent blood test has just shown my platelets have fallen by nearly 300 in 6 weeks, so below 1500 again.)

I quite like this treatment guideline, see fig. 1.

Essential thrombocythemia treatment algorithm 2018.

nature.com/articles/s41408-...

[Magentas in reply to Amethist]

Looks like a very worthwhile contribution, Amethist. This is all out of my hands now as stage 2 fibrosis is a whole other ball game.

[Whitehair51 in reply to Amethist]

Thanks for the link, very illuminating!

[Jenny_F]

I think it depends on many risk factors, age, weight, history, platelet numbers. I go to Guys Hospital and I have always taken 1 aspirin a day as advised. My levels are around 900 and I am 49. I am overweight but who isn’t due to lockdown snacking! I am doing s programme on Noom to try and lose some.

[azaelea]

Hi Magentas. Was your initial diagnosis ET and has it progressed to MF? So glad you’ve got a great haematologist now. Will make things much easier for you. All the best, Fran

[Magentas in reply to azaelea]

Hi Fran, yes it was, so I’m pretty damn sad, intermittently....ET was a breeze compared. Who knows if she’s great but she’s all I’ve got. Hope you are doing ok. x

[azaelea in reply to Magentas]

So sorry you’re not too good. I’m not bad thanks apart from my sore bone on wrist which Haemo (from my description) thought was Gout which I’m not convinced about. I’m trying to get an appointment with GP to actually see it but they’re not taking advance appointments so have to ring at 8am for a slot. Not till Wednesday tho as full till then I’m told. Our lives in their hands! xx

[Magentas in reply to azaelea]

So true ‘our lives in their hands’! And more than ever there for you guys over there with covid. 🤞 for the correct diagnosis and that the bone pain can be treated. If only it was just a ganglion cyst, I had one of those in my 30’s and bashed it with a book (the recommended cure) pft, gone!

[Lifam]

I agree totally with Hunter