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Background. Thrombotic complications may impact mortality and morbidity in chronic myeloproliferative neoplasms (MPNs) mainly polycythemia vera (PV) and essential thrombocythemia (ET). However, the underlying mechanisms involved are not clear, though abnormalities in blood viscosity, activated platelets and leukocytes, leukocytosis, hypercoagulability status may be risk factors for developing clinical vascular events. Presence of JAK2 V617F allele burden as well as serum thrombopoetin level are associated with increased risk of thrombosis. We sought to define risk factors for vascular complications (VC) in MPNs patients. Materials and methods. We prospectively included 25 MPNs patients with stroke or myocardial infarction and 18 MPNs patients without VC. To identify the patterns of platelet response in MPNs patients with or without VC, comparative platelet aggregation tests using ADP, collagen, epinephrine, ristocetin assessing amplitude, and slope were performed. The additional evaluated biomarkers were of major clinical and laboratory nature. Results. MPNs patients with VC exhibited higher Hb, higher number of leukocytes, larger platelet counts vs. MPNs patients without VC (Leukocytes 12280/mmc vs. 7195/mmc p=0.03; Hemoglobin (Hb) 15.45g/dl vs. 12.75g/dl, p=0.03; Hematocrit (Ht) 47.03 vs. 39.1, p=0.02). Count of platelets it is not very important. Arterial hypertension (52.63% vs. 4.34% OR 24.44, p = 0.0044) was the most prominent biomarker predicting VC. Platelet response was also different (amplitude curve: collagen 31.45 vs. 53.64, p = 0.03; ristocetin 61.25 vs. 41.5, p=0.03; slope curve collagen 82.4 vs. 46.65, p = 0.03, ristocetin 81.66 vs. 54.5, p=0.05) suggesting higher aggregation in MPN patients with VC. Conclusion. Arterial hypertension is an independent clinical predictor of VC in MPNs patients with arterial hypertension. High blood viscosity and impaired platelet response to collagen and ristocetin may serve as laboratory biomarkers for VC in such high-risk patients. Identifying prognostic biomarkers and their link to clinical outcomes in MPN patients is warranted.