DVT Prevention in Travelers

1. See Also
   1. Deep Vein Thrombosis
   2. Deep Vein Thrombosis Prevention
   3. Travel Preparation
   4. Air Travel Restriction
2. Indications: Prevention of DVT on Flights >4 hours
   1. Hypercoagulable State
   2. Age over 50 years
   3. Prior Venous Thromboembolism
   4. Recent surgery
   5. Recent Trauma
   6. Estrogen or Oral Contraceptive use
   7. Active cancer
   8. Pregnancy
   9. Morbid Obesity
   10. Large Varicose Veins
3. Management: Low risk for DVT and flight >4 hours
   1. Indications
      1. No moderate or high risk indications below
   2. Walk 10-15 minutes each 1-2 hours of flight
   3. Avoid window seats (85% of DVTs occur in non-aisle seats)
   4. Maintain adequate hydration
   5. Avoid Alcohol
   6. Lower extremity Isometric Exercises while seated
4. Management: Moderate Risk for DVT and flight >4 hours
   1. Indications
      1. History of Venous Thromboembolism (DVT or PE)
      2. Surgery duration >30 minutes in last 4-6 weeks
      3. Known Thrombophilia
      4. Pregnancy
      5. Body Mass Index (BMI) > 30
   2. Also follow Low Risk precautions above
   3. Wear graduated Compression Stockings during flight
      1. Below the knee Compression Stockings (20-30 mmHg)
      2. Require prescription and measurements for proper fitting (may be covered by insurance)
      3. Clarke (2021) Cochrane Database Syst Rev (4):CD004002 +PMID:27624857 [PubMed]
   4. Aspirin 80 to 325 mg orally daily is controversial
      1. Not routinely recommended as unlikely to be effective
5. Management: High Risk for DVT and flight >4 hours
   1. Indications
      1. History of Venous Thromboembolism AND
      2. Additional significant risk factors (e.g. active cancer, surgery >30 minutes within last 4 weeks)
   2. Also follow Low and Moderate Risk precautions above
   3. Low Molecular Heparin (LMWH, Enoxaparin, Lovenox)
      1. Dose 40 mg SC on day of travel prior to flight and the next day
   4. DOAC (e.g. Rivaroxaban 10 mg or Apixaban)
      1. May be considered as alternative to LMWH (has not been studied)
6. Course
   1. Venous Thromboembolism may be attributable to travel if event occurs within 8 weeks of travel
      1. Typical onset within 2-3 weeks of travel
7. References
   1. Bartholomew (2011) Cleve Clin J Med 78(2): 111-20 [PubMed]
   2. Scurr (2001) Lancet 357:1485-9 [PubMed]
   3. Smith (2010) Heart 96(suppl 2):ii1-16 [PubMed]
   4. Watson (2011) Br J Haematol 152: 31-4 [PubMed]