In a related editorial, the authors note that this study shows that the traditional approach to assessing thrombotic risk in patients with myeloproliferative neoplasms (MPNs) (age ≥60 years, prior thrombotic event, and presence of traditional cardiovascular risk factors) lacks precision and personalisation. A personalized, precision medicine approach to primary and secondary thrombosis prevention for patients with MPNs should incorporate genomics, cardiovascular risk assessment, inflammatory biomarkers, and this new appreciation of the magnitude and cumulative nature of excess risk.