Is there a role to continue aspirin in patients with myeloproliferative disorders who have never had a thrombotic event that are starting DOAC for stroke prophylaxis with newly diagnosed atrial fibrillation?

Aside from treating erythromelalgia, transient ischemic attacks (TIA) such as ocular migraine or documented atherosclerotic disease, aspirin has no role in the management of the MPN, despite the widely published recommendations for its use, particularly in so-called "high risk" polycythemia vera (PV) and essential thrombocytosis (ET) patients. Risk being defined as age > 60 years, a prior thrombosis, or a platelet count greater than 1,000,000/mL.

To begin, it has been definitely demonstrated that in patients between ages 50-59, low dose aspirin is effective in the reduction of coronary artery disease (CAD) in patients with a >10% risk of developing this; it may also prevent colon cancer. If your MPN patient has no CAD risk factors and, in p...

This is a good question. In my practice, unless the patient has had an arterial event- such as TIA/CAD, I do not feel strongly that they need to continue ASA while on a DOAC. The risk of bleeding likely outweighs the benefit of the anti-platelet action.