Grant: Project Grant

Polycythemia vera, essential thrombocythemia, and primary myelofibrosis are three rare types of cancer of the bone marrow known as myeloproliferative neoplasms (MPN). Patients with MPN with a particular mutation (called JAK2 positive) are at high risk of developing blood clots in both the arteries and the veins. In order to reduce the risk of blood clots, physicians recommend to take a low-dose aspirin once per day, in addition to other medications, including chemotherapy. Unfortunately, even with the use of aspirin, these patients remain at high risk of blood clots, which can lead to devastating consequences such as stroke, heart attack, pulmonary embolism, or even death. The purpose of this study is to determine whether low-dose oral anticoagulants, called apixaban or rivaroxaban, are better at preventing blood clots in patients with JAK2-positive MPN, compared to aspirin. In previous studies done in different patient populations, low-dose oral anticoagulants have been shown to be better than aspirin at preventing venous blood clots, and at least as good as, or slightly better, than aspirin at preventing arterial clots. This study will randomly assign the participants to either receive a low-dose oral anticoagulant or to continue on aspirin. We want to find out how many blood clots can be prevented when JAK2-positive MPN patients take a low-dose oral anticoagulant, compared to aspirin. We also want to monitor whether there is a difference in the number of bleeding complications between low-dose oral anticoagulants and aspirin in this patient population. Through our proposed trial, we aim to find a new use for medications that are already on the market (low-dose oral anticoagulants) and improve the health of patients living with MPN. This work will also provide us with an opportunity to learn more about rare cancers, which have not been well examined in prior studies focusing on the prevention of blood clots in cancer patients.