In patients with high-risk polycythemia vera with a history of thrombosis, should aspirin be used in addition to indefinite anticoagulation and cytoreduction for prevention of recurrent thrombosis?   

I do not continue aspirin in patients who require anticoagulation out of concern for an increased risk of bleeding. In an analysis of the REVEAL database, patients receiving anticoagulation in combination with aspirin were over 4-fold as likely to have a hemorrhage (HR [95% CI] = 4.22 [2.57, 6.94]; ...