Case reports in hematology
Pacritinib-Based Salvage Therapy in High-Risk Polycythaemia Vera With Recurrent Arterial and Venous Thrombosis After Hydroxyurea and Ruxolitinib: A Case Report
By Al-Rasheed M.
Abstract
Objectives
Polycythaemia vera (PV) is associated with substantial arterial and venous thrombotic risk, particularly in patients with prior thrombosis and inadequate haematocrit (HCT) control. Although ruxolitinib is an established second-line treatment after hydroxyurea failure or intolerance, some patients remain difficult to manage. We report a case of highly thrombotic, treatment-challenging PV in which pacritinib-based salvage therapy was used after inadequate disease control with hydroxyurea and ruxolitinib.
Case presentation
A 44-year-old man was referred with portal vein thrombosis and a history of premature myocardial infarction and cerebrovascular accident. Investigations demonstrated JAK2V617F-positive PV with borderline low erythropoietin and bone marrow panmyelosis. Despite antiplatelet therapy, anticoagulation, hydroxyurea and subsequent ruxolitinib, the patient experienced further thrombotic complications, including recurrent cerebrovascular events, bilateral limb ischaemia and left ventricular thrombosis. Ruxolitinib was escalated to 25 mg twice daily and combined with low-dose hydroxyurea; however, HCT control remained suboptimal, with recurrent need for venesection. In February 2025, ruxolitinib was replaced with pacritinib 200 mg twice daily while hydroxyurea and warfarin were continued. During follow-up, the patient achieved improved HCT control, no longer required venesection and had no further documented thrombotic events. Pacritinib was well tolerated.