II. Indications: Prevention of DVT on Flights >4 hours
- Hypercoagulable State
- Age over 50 years
- Prior Venous Thromboembolism
- Recent surgery
- Recent Trauma
- Estrogen or Oral Contraceptive use
- Active cancer
- Pregnancy
- Morbid Obesity
- Large Varicose Veins
III. Management: Low risk for DVT and flight >4 hours
- Indications
- No moderate or high risk indications below
- Walk 10-15 minutes each 1-2 hours of flight
- Avoid window seats (85% of DVTs occur in non-aisle seats)
- Business class seats with more leg room do not appear to decrease DVT Risk
- Maintain adequate hydration
- Avoid Alcohol
- Lower extremity Isometric Exercises while seated
- Avoid crossing legs while seated
IV. Management: Moderate Risk for DVT and flight >4 hours
- Indications
- History of Venous Thromboembolism (DVT or PE)
- Surgery duration >30 minutes in last 4-6 weeks
- Known Thrombophilia
- Pregnancy
- Body Mass Index (BMI) > 30
- Also follow Low Risk precautions above
- Wear graduated Compression Stockings during flight
- Below the knee Compression Stockings (20-30 mmHg)
- Require prescription and measurements for proper fitting (may be covered by insurance)
- Clarke (2021) Cochrane Database Syst Rev (4):CD004002 +PMID:27624857 [PubMed]
-
Aspirin 80 to 325 mg orally daily is controversial
- Not routinely recommended as unlikely to be effective
V. Management: High Risk for DVT and flight >4 hours
- Indications
- History of Venous Thromboembolism AND
- Additional significant risk factors (e.g. active cancer, surgery >30 minutes within last 4 weeks)
- Also follow Low and Moderate Risk precautions above
- Low Molecular Heparin (LMWH, Enoxaparin, Lovenox)
- Dose 40 mg SC on day of travel prior to flight and the next day
-
DOAC (e.g. Rivaroxaban 10 mg or Apixaban)
- May be considered as alternative to LMWH (has not been studied)
VI. Course
-
Venous Thromboembolism may be attributable to travel if event occurs within 8 weeks of travel
- Typical onset within 2-3 weeks of travel
- Patients should be alert for Leg Edema or pain, Shortness of Breath or Chest Pain