Confused - High Platelet Count - Risk of embolisms or bleeding.

[Buggerbear]

I have heard from my doctor I am more at risk for embolisms with high platelet count, but I have also read and heard there is more of a risk for bleeding.

Please share your knowledge or experience. Thank you.

[mhos61]

The general consensus is platelets above 1500 is a risk factor for bleeding. Although it’s not always that simple.

After looking at your profile I note that you have had blood clots twice in the past. You also have APS, which is also another risk factor for blood clots.

My guess is your Doctor’s statement ‘You are more at risk for embolisms with a high platelet count’ is that he is specifically referring to you by considering your past medical history rather than making a generalised comment.

[Buggerbear in reply to mhos61]

Thank you mhos61! What you say makes absolutely good sense and guess I wasn't just thinking about me. We are all different with different problems trying to live the best life we can. I appreciate you taking the time to look at my profile!!

[mhos61 in reply to Buggerbear]

You’re more than welcome.

Exactly that, we’re all different and bring our own personal mix to our flavour of MPN. Doctors have to work with that knowledge and hopefully work in our best interest.

You could always ask your healthcare professional for further clarification too.

All the best!

[Wyebird]

strange isn’t it but yet true we are susceptible to both but I would regard the clots for more seriously.

[Buggerbear in reply to Wyebird]

Yes I really hope there isn't a 3rd time for me with clots. Hope you are doing well Wyebird!!

[Wyebird]

oh no you’ve had clots! I’m really well on Peg thanks

[hunter5582]

Thrombocytosis puts one at risk for both thrombosis and hemorrhage. While there is not a linear relationship between the level of thrombocytosis and the degree of risk thrombosis, there is a linear relationship with risk of hemorrhage. The higher the platelets, the higher the risk of hemorrhage. The reasons for this have to do with how platelets behave, not just how many there are,

With higher platelet levels there is a risk of Acquired von WIllbrand Disease. Typically thought to occur with PLT > 1,500, it is known to occur at lower levels. It is also known that thrombocytosis can also cause increased hemorrhage (bleeding/bruising) without reaching the level of AcqvWBD. One factor is that thrombocytosis can cause a decrease in the von Willebrand Factors needed for clotting without being severe enough to qualify for the disease diagnosis,

Taking aspirin increases the risk of hemorrhage. This is an intrinsic risk of the antiplatelet medications. The risk of hemorrhage has to be balanced with the risk of thrombosis when not using antiplatelet medications. For most, with MPNs, the benefits of aspirin outweigh the risks.

If you have a prior history of thrombosis, including embolisms, then preventing recurrence is a critical treatment issue. Cytoreduction is indicated along with antiplatelet treatment. Cytoreduction for most will reduce the risks of both thrombosis and hemorrhage.

Hope that helps to answer what is actually a rather complicated question.

[Buggerbear]

Thank you Hunter for always coming to the rescue!!

I was tested in 2019 for Von Willebrand Disease and it was negative. I did test positive for the aPL (lupus anticoagulant) . I was just retested in 2023 for an extended antiphospholipid antibody panel and showed an elevated anti-cardiolipin lgG .

My platelets usually stay around 600 (sometimes higher) which concerns my Dr. as he keeps raising the dosage of Jakafi which in turn make me more anemic. I tried Anagrelide for a couple of years, but finally asked to stop it because of the heart palpitations. It really didn't bring my platelets down. I have taken aspirin since 2014 when I was actually diagnosed with MPN's.

I have had pulmonary embolisms twice, but think the last time was because hospital stopped my blood thinner. I know now never to do that unless it is a life or death situation.

I have not heard of cytoreduction but hopefully the JAK2 inhibitor will keep working! I guess I haven't been as worried about platelet numbers until recently.

Thank you again and so glad your journey taking Besemi is so successful!!