Long distance air travel may increase a person's risk for developing deep vein thrombosis with resultant embolic phenomena. The House of Lords (England) Select Committee on Science and Technology has published guidelines to reduce the risk of thrombosis during air travel.
|
Parameter |
Finding |
Risk |
|
duration of flight |
< 5,000 kilometers and < 8 hours |
low |
|
|
>= 5,000 kilometers or >= 8 hours |
moderate |
|
|
>= 5,000 kilometers or >= 8 hours with history of venous thromboembolism |
high |
|
congestive heart failure |
absent or LVEF > 44% |
low |
|
|
left ventricular ejection fraction 20-44% |
moderate |
|
|
left ventricular ejection fraction < 20% |
high |
|
recent AMI |
|
moderate |
|
hormone replacement therapy or oral contraceptives |
|
moderate |
|
pregnancy |
|
moderate |
|
clinical hypercoagulable state |
|
high |
|
recent major surgery within past 6 weeks |
|
high |
|
malignancy with hypercoagulable state |
|
high |
from Possick and Barry
The risk category is the highest rating for all of the parameters listed.
|
Risk Group |
Recommendation |
|
low risk |
Move around in seat or in the cabin as much as practicable. |
|
|
Exercise calf muscles while seated. |
|
|
Avoid excess alcohol and drinks containing caffeine. |
|
|
Keep well hydrated. |
|
|
Observe and act on advice given in in-flight media. |
|
moderate risk |
All of the recommendations for low risk group. |
|
|
Seek professional advice about risks prior to travel. |
|
|
If advised to, take low dose aspirin prior to the flight unless contraindicated. |
|
|
Follow professional advice about the need to wear compression stockings. |
|
|
Get an aisle seat to allow for walking during flight. |
|
high risk |
All of the recommendations for the low and moderate risk groups. |
|
|
Consider postponing or cancelling the flight. |
|
|
If advised to, take low molecular weight heparin prior to the flight unless contraindicated or taking coumadin. |
Things to avoid:
(1) being immobile or cramped for prolonged periods
Additional options for patients at moderate-to-high risk:
(1) Take an alternative means of transportation (cruise ship, etc.).
(2) Break a long haul trip into several shorter flights.
(3) Treat conditions associated with increased risk for thrombosis.
Specialty: Emergency Medicine, Critical Care
