Apixaban/rivaroxaban Versus Aspirin for primary prevention of thrombo-embolic complications in JAK2V617F-positive myeloproliferative neoplasms

Prior treatment

• Formal indication of treatment with LDA or DOAC (thus precluding randomization)
• Concomitant use of a strong inhibitor or inducer of CYP3A4 (like Ruxolitinib)

Other illness

• Contra-indication to aspirin or DOAC due to allergic situation or recent history of major bleeding
• Chronic liver disease or chronic hepatitis
• Patient considered at high-risk of bleeding: patients with current or recent major or clinically relevant non major bleeding gastrointestinal or cerebral bleedings

Lab values

• Renal insufficiency with creatinine <30 ml/mn on Cockcroft and Gault Formula

Age

• No appropriate contraception (estrogen contraception or no contraception) in women of childbearing age or breastfeeding woman

Other

• PS>2 or life expectancy <12 months
• Inability to give informed consent
• Patients under curatorship/guardianship
• Planned pregnancy within 24 months

• Patients with diagnosis of Polycythemia Vera or Essential Thrombocythemia or Prefibrotic myelofibrosis according to WHO or BSCH criteria (bone marrow biopsy not compulsory).
• Patients with JAK2V617F mutation (threshold allele burden > 1%).
• Patients considered as “high-risk” patients: - 1°) based on age (> 60-year-old) - 2°) based on thrombotic history (compatible with antithrombotic randomization) but aged ≥ 18-year-old
• Length of time from MPN diagnostic to inclusion will not exceed 12 months