Aspirin Discontinuation and Acute Coronary Syndrome in a Case of JAK2 V617F-Positive Polycythemia Vera: A Case Report

Abstract

Polycythemia vera (PV) is a JAK2-mutated myeloproliferative neoplasm characterised by clonal erythrocytosis and a substantially elevated lifetime risk of arterial and venous thrombosis. We present a 66-year-old man with JAK2 V617F-positive PV diagnosed 15 months earlier, who had a history of type 2 diabetes mellitus, hypertension and chronic kidney disease. The patient was managed with serial therapeutic venesection, initially performed once weekly for six months to achieve adequate haematocrit control, followed by gradual tapering to monthly maintenance sessions. Concurrently, the patient received low-dose aspirin. After independently discontinuing monthly venesection and low-dose aspirin for three months, he presented with chest discomfort radiating to the upper back. Serial electrocardiograms showed ST-T changes across the inferior and anteroseptal leads, and high-sensitivity troponin I was markedly elevated. Echocardiography confirmed inferior wall hypokinesia with fair left ventricular systolic function. Coronary angiography revealed single-vessel disease with an 80% discrete stenosis of the distal right coronary artery, successfully treated with percutaneous angioplasty and drug-eluting stent implantation with restoration of TIMI III flow. The patient was managed with standard ACS care. This case differs from most published PV-associated acute coronary syndrome reports, which typically describe PV first diagnosed at presentation with a high-thrombus-burden ST-elevation event or angiographically non-obstructive coronary arteries; here, PV was already established and biochemically controlled, and the culprit lesion was a discrete, fixed atherosclerotic stenosis that responded to conventional angioplasty, with aspirin withdrawal identifiable as the probable precipitant. The case reinforces the need for uncompromising adherence to antiplatelet therapy and combined haematology-cardiology follow-up in PV patients who carry additional conventional cardiovascular risk factors.