How would you manage JAK2+ polycythemia vera during pregnancy and postpartum?

There are not a lot of data to guide us given the relative rarity of PV in adults of child-bearing age but two published studies may be helpful.

An analysis of 129 pregnancies in patients with PV demonstrated that the combination of aspirin plus LMWH had a significantly lower risk of a spontaneous abortion/stillbirth (Wille et al., PMID 37153877).

A meta-analysis of 1,210 pregnancies in patients with MPNs found that aspirin use was associated with a significantly lower risk of spontaneous abortion/stillbirth but not heparin. Of note, this studies that mostly patients with ET and not PV (Maze et al., PMID 31584685)

With that in mind, I think aspirin should be recommended for the patient along with having a risk/benefit discussion about LMWH. Ma...

I agree completely with Dr. @Dr. First Last. We know that aspirin throughout pregnancy (How et al., PMID 33022566) helps outcomes. I use it in all patients regardless of traditional IPSET risk during pregnancy if they have ET. Consensus guidelines recommend 6 weeks of LMWH postpartum also. Phlebotomy should be done regularly during pregnancy although most women don’t need it as often (baby is great at lowering hemoglobin!)

Asprin through the duration of pregnancy and to consider LMWH x 6 weeks post-partum during the period of highest risk