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DVT Prevention in Travelers
Aka: DVT Prevention in Travelers, Travel-Related Deep Vein Thrombosis Prevention
- See Also
- Deep Vein Thrombosis
- Deep Vein Thrombosis Prevention
- Travel Preparation
- Air Travel Restriction
- 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
- 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)
- Maintain adequate hydration
- Avoid Alcohol
- Lower extremity Isometric Exercises while seated
- 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
- 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)
- Course
- Venous Thromboembolism may be attributable to travel if event occurs within 8 weeks of travel
- Typical onset within 2-3 weeks of travel
- References
- Bartholomew (2011) Cleve Clin J Med 78(2): 111-20 [PubMed]
- Scurr (2001) Lancet 357:1485-9 [PubMed]
- Smith (2010) Heart 96(suppl 2):ii1-16 [PubMed]
- Watson (2011) Br J Haematol 152: 31-4 [PubMed]