Essential thrombocytosis surgery

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Soujanya Thummathati, MBBS [2]Parth Vikram Singh, MBBS[3]

Surgical intervention is not recommended for the management of essential thrombocytosis.

Perioperative management should have a multidisciplinary approach involving hematology and the surgical team.

Some experts target preprocedure platelet counts <450 x 10^9/L in high-risk and <600 x 10^9/L in low-risk patients.^[1] Achieving the low-risk target may require a short course of hydroxyurea. Evidence is lacking for perioperative aspirin/anticoagulation decisions specific to ET, so experts recommend following general perioperative guidelines for people without ET.

Surgical intervention is not recommended for the management of essential thrombocytosis.

Perioperative management should have a multidisciplinary approach involving hematology and the surgical team.

Some experts target preprocedure platelet counts <450 x 10^9/L in high-risk and <600 x 10^9/L in low-risk patients.^[2] Achieving the low-risk target may require a short course of hydroxyurea.

Evidence is lacking for perioperative aspirin/anticoagulation decisions specific to ET, so experts recommend following general perioperative guidelines for people without ET.

In a retrospective review of 66 patients undergoing 121 procedures,^[3] there was no perioperative bleeding; 90-day postoperative risks were 1% arterial thrombosis, 1% venous thrombosis, 4% hemorrhage, and 2% death. Findings suggest continuing cytoreductive and aspirin therapy may be reasonable for most surgeries unless the procedure has high bleeding risk.

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