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2013]. This whole area of hemostasis and cell interaction is currently undergoing a vigorous expansion and may provide important information on thrombotic risk management in MPN. Symptom burden in ET The attitude to patient complaints of fatigue and other symptoms in ET has previously  been one of skepticism among many doctors. Many patients probably have been told that ��you don��t get tired by having increased platelets��. And it is true that about 50% of newly diagnosed ET patients are asymptomatic. However, recent studies have shown that ET patients have a significant symptom burden with an effect on quality of life (QoL). In an international effort, a symptom assessment tool specific to the MPN population was developed [Emanuel et al. 2012] and validated [Scherber et al. 2011]. It is now available in many languages to be used both for research purposes and as a clinical tool in the individual patient. The most commons symptoms are constitutional like fatigue, night sweats and weight loss, as well as resulting  from microvascular complications like headache, dizziness and erythromelalgia [Scherber et al. 2011]. Additionally, about 20% of ET patients have experienced thrombosis before or at diagnosis. The use of risk stratification and risk score models As shown above a number of new risk score models have been presented over the past few years. It seems important to realize that a risk score model may be helpful in [http://en.wikipedia.org/wiki/GNAT2 GNAT2] further defining a patient��s risk, but equally important that such a model is only a first step towards an instrument for treatment decisions. In a recent study, the usefulness of the IPSET-thrombosis score model was tested against the traditional risk factors age and previous thrombosis, and was not found to add any further, useful information [Angona et al. 2014]. Ideally, randomized treatment studies proving the usefulness of a treatment decision should be used. However, with several factors indicating a lower thrombotic risk and as many indicating the opposite, it is very unlikely that there will be randomized studies large enough to validate a specific model.  Therefore, a pragmatic approach seems warranted. The classical risk stratification based on age and previous thrombosis indicating high risk status is still useful, as well as platelets >1500?��?109/l indicating high risk for hemorrhage. The importance of reducing CV risk factors can hardly be questioned and this should therefore always be evaluated in the individual patient. Whether, for example, a low risk ET patient (age 15 and CV risk factors should be treated as a high risk with aspirin and cytoreduction cannot for the moment be answered by risk score models, but is up to the judgment of the treating physician.