American Board of Internal Medicine (ABIM) Certification Practice Exam

Which treatment is indicated for patients with Polycythemia Vera who are younger than 60 years without a previous thromboembolic event?

1. Hydroxyurea

2. Phlebotomy and low-dose aspirin

3. Interferon therapy

4. Chemotherapy

The correct answer is: Phlebotomy and low-dose aspirin

In patients with Polycythemia Vera who are younger than 60 years and do not have a previous thromboembolic event, the initial management typically involves phlebotomy and low-dose aspirin. This approach is considered a first-line treatment because it effectively controls symptoms and reduces the risk of thrombosis. Phlebotomy serves to reduce elevated hematocrit levels, which is essential since high red blood cell mass increases the risk of thrombotic complications. Keeping the hematocrit below a certain threshold mitigates this risk and improves patient outcomes. Alongside phlebotomy, low-dose aspirin is recommended to further decrease the likelihood of clotting events. Aspirin works as an antiplatelet agent, helping to minimize the potential for thrombosis in these patients. In contrast, hydroxyurea is typically reserved for patients who have a higher risk of thromboembolic events or for those who cannot tolerate phlebotomy alone, making it less suitable as a first-line therapy in this specific demographic (younger patients without a history of thromboembolism). Interferon therapy may also be used but is more commonly indicated in certain circumstances or for patients who are intolerant of other treatments. Chemotherapy is not indicated as