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Evidence Suggests Link Between Travel and Deep Vein Thrombosis Only In High-Risk Individuals
A DGReview of :"Travellers' thrombosis and economy class syndrome: incidence, aetiology and prevention"
Clinical and Laboratory Haematology
10/07/2003
By Emma Hitt, PhD
A probable link exists between thrombosis and long distance travel; however, this association is confined to individuals with additional risk factors, and fatal pulmonary embolus is very rare, conclude the authors of a new review article.
In their report, Denis O'Keeffe, MD, with the Haematology Department at Addenbrooke's Hospital, Cambridge, United Kingdom, and colleagues discussed the evidence supporting and disputing the link between travelling and thrombosis; the aetiology of thrombosis in travellers; and ways to prevent venous thromboembolism (VTE) while travelling.
According to the authors, several studies support the concept of an increased risk of asymptomatic deep vein thrombosis (DVT) in association with travel. However, other studies do not support such an association.
The authors drew several conclusions based on the evidence. "First, there does appear to be an association between VTE and long-distance travel," they note. "Second, fatal PE is very rare. Third, any association appears to be confined to individuals with additional risk factors. Fourth, criteria for high-risk travellers are not well defined."
Regarding the aetiology of thrombosis in travellers, Dr. O'Keeffe and colleagues suggest that long journeys in any type of cramped transportation, appear to be the most likely trigger of thrombosis. However, plane travel may carry additional potential risk factors of dehydration and alcohol/sedative consumption.
They suggest that physicians' can counsel patients to exercise the calf muscles while seated, and avoid dehydration, alcohol, and sedatives. In addition, below-knee compression stockings may reduce the incidence of symptomatic DVT, they suggest.
Drug therapy for preventing DVT, such as aspirin and low molecular-weight heparin (LMWH), has side effects that should be weighed against a beneficial effect. The authors state they reserve the use of LMWH, at a single dose of 40 mg enoxaparin, for a minority of individuals with multiple risk factors and travel for more than 6 hours, on a case-by-case basis.
"Any association between VTE and travel is confined to at risk individuals," they conclude, and these may include people with previous VTE; body weight greater than 40 kg/m2, metastatic cancer, and those who have undergone major surgery in the previous 2 weeks.
Clin Lab Haematol 2003 Oct;25:5:277-81.
"Travellers' thrombosis and economy class syndrome: incidence, aetiology and prevention"
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