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ET patients have traditionally been stratified into two thrombosis risk categories based on age older than 60\u2009years and a history of thrombosis. More recently, the revised IPSET\u2010thrombosis scoring system, which accounts for the increased risk linked to the <jats:italic>JAK2<\/jats:italic> mutation, has been incorporated into most expert recommendations. However, there is increasing evidence that the term ET encompasses different genomic entities, each with a distinct clinical course and prognosis. Moreover, the effectiveness and toxicity of cytoreductive and anti\u2010platelet treatments differ depending on the molecular genotype. While anti\u2010platelets and conventional cytoreductive agents, mainly hydroxycarbamide (hydroxyurea), anagrelide and pegylated interferon, remain the cornerstone of treatment, recent research has shed light on the effectiveness of novel therapies that may help improve outcomes. 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