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Prevention of venous thromboembolism in adult travelers

Menaka Pai, MD, FRCPC
James D Douketis, MD, FRCPC, FACP, FCCP
Section Editors
Lawrence LK Leung, MD
Jess Mandel, MD
Deputy Editor
Geraldine Finlay, MD


Long-distance travel confers a small increased risk of venous thromboembolism (VTE). This topic review discusses the risk and prevention of VTE in travelers.

Approaches to the prevention of VTE in hospitalized medical and surgical patients and patients with cancer and stroke, as well as patients who are pregnant, are presented separately. (See "Prevention of venous thromboembolic disease in acutely ill hospitalized medical adults" and "Prevention of venous thromboembolic disease in surgical patients" and "Medical complications of stroke", section on 'VTE prophylaxis' and "Risk and prevention of venous thromboembolism in adults with cancer" and "Deep vein thrombosis and pulmonary embolism in pregnancy: Prevention".)


Long-distance travel, either by air or land, confers a small increased risk of venous thromboembolism (VTE) [1-14]. The rates are higher in those who travel for prolonged periods and is greatest in the first two weeks after travel.

The incidence of VTE in travelers is low with higher rates reported when both asymptomatic and symptomatic VTE are included in the analysis [4,9,11,12,15,16]. One study reported the overall incidence of symptomatic VTE as 0.5 percent for flights >12 hours, while other studies report rates of asymptomatic VTE as high as 1.5 percent to 10 percent during extended travel of 24 hours or longer [4,11,12,15,17-19].

The estimated risk of VTE during extended travel by air or land (eg, car, train, bus) is variable (increased approximately two- to fourfold). The highest risk is reported in those who spend longer periods of time traveling. In one meta-analysis of 14 studies, the pooled risk for VTE in travelers, compared with non travelers, was 2.8 (95% CI 2.2-3.7) [9]. Another meta-analysis reported that the risk of VTE increases every two hours by 18 percent for travel by any mode, and by 26 percent for air travel [9].


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Literature review current through: Sep 2016. | This topic last updated: Jul 17, 2015.
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  1. Pérez-Rodríguez E, Jiménez D, Díaz G, et al. Incidence of air travel-related pulmonary embolism at the Madrid-Barajas airport. Arch Intern Med 2003; 163:2766.
  2. Ferrari E, Chevallier T, Chapelier A, Baudouy M. Travel as a risk factor for venous thromboembolic disease: a case-control study. Chest 1999; 115:440.
  3. Kelman CW, Kortt MA, Becker NG, et al. Deep vein thrombosis and air travel: record linkage study. BMJ 2003; 327:1072.
  4. Scurr JH, Machin SJ, Bailey-King S, et al. Frequency and prevention of symptomless deep-vein thrombosis in long-haul flights: a randomised trial. Lancet 2001; 357:1485.
  5. Giangrande PL. Air travel and thrombosis. Br J Haematol 2002; 117:509.
  6. Schwarz T, Siegert G, Oettler W, et al. Venous thrombosis after long-haul flights. Arch Intern Med 2003; 163:2759.
  7. Martinelli I, Taioli E, Battaglioli T, et al. Risk of venous thromboembolism after air travel: interaction with thrombophilia and oral contraceptives. Arch Intern Med 2003; 163:2771.
  8. Lapostolle F, Surget V, Borron SW, et al. Severe pulmonary embolism associated with air travel. N Engl J Med 2001; 345:779.
  9. Chandra D, Parisini E, Mozaffarian D. Meta-analysis: travel and risk for venous thromboembolism. Ann Intern Med 2009; 151:180.
  10. MacCallum PK, Ashby D, Hennessy EM, et al. Cumulative flying time and risk of venous thromboembolism. Br J Haematol 2011; 155:613.
  11. WHO Reserach Into Global Hazards of Travel (WRIGHT) Project. Final report of phase 1. Available at: www.who.int/cardiovascular_diseases/wright_project/phase1_report/WRIGHT%20REPORT.pdf (Accessed on May 14, 2010).
  12. Kuipers S, Venemans A, Middeldorp S, et al. The risk of venous thrombosis after air travel: contribution of clinical risk factors. Br J Haematol 2014; 165:412.
  13. Kuipers S, Venemans-Jellema A, Cannegieter SC, et al. The incidence of venous thromboembolism in commercial airline pilots: a cohort study of 2630 pilots. J Thromb Haemost 2014; 12:1260.
  14. Naouri D, Lapostolle F, Rondet C, et al. Prevention of Medical Events During Air Travel: A Narrative Review. Am J Med 2016; 129:1000.e1.
  15. Kuipers S, Cannegieter SC, Middeldorp S, et al. The absolute risk of venous thrombosis after air travel: a cohort study of 8,755 employees of international organisations. PLoS Med 2007; 4:e290.
  16. Philbrick JT, Shumate R, Siadaty MS, Becker DM. Air travel and venous thromboembolism: a systematic review. J Gen Intern Med 2007; 22:107.
  17. Kuipers S, Schreijer AJ, Cannegieter SC, et al. Travel and venous thrombosis: a systematic review. J Intern Med 2007; 262:615.
  18. Watson HG. Travel and thrombosis. Blood Rev 2005; 19:235.
  19. Adi Y, Bayliss S, Rouse A, Taylor RS. The association between air travel and deep vein thrombosis: systematic review & meta-analysis. BMC Cardiovasc Disord 2004; 4:7.
  20. Watson HG, Baglin TP. Guidelines on travel-related venous thrombosis. Br J Haematol 2011; 152:31.
  21. Possick SE, Barry M. Evaluation and management of the cardiovascular patient embarking on air travel. Ann Intern Med 2004; 141:148.
  22. Paganin F, Bourdé A, Yvin JL, et al. Venous thromboembolism in passengers following a 12-h flight: a case-control study. Aviat Space Environ Med 2003; 74:1277.
  23. Gajic O, Warner DO, Decker PA, et al. Long-haul air travel before major surgery: a prescription for thromboembolism? Mayo Clin Proc 2005; 80:728.
  24. Arya R, Barnes JA, Hossain U, et al. Long-haul flights and deep vein thrombosis: a significant risk only when additional factors are also present. Br J Haematol 2002; 116:653.
  25. Hughes RJ, Hopkins RJ, Hill S, et al. Frequency of venous thromboembolism in low to moderate risk long distance air travellers: the New Zealand Air Traveller's Thrombosis (NZATT) study. Lancet 2003; 362:2039.
  26. Arfvidsson B, Eklof B, Kistner RL, et al. Risk factors for venous thromboembolism following prolonged air travel. Coach class thrombosis. Hematol Oncol Clin North Am 2000; 14:391.
  27. Kesteven P, Robinson B. Incidence of symptomatic thrombosis in a stable population of 650,000: travel and other risk factors. Aviat Space Environ Med 2002; 73:593.
  28. Cannegieter SC, Doggen CJ, van Houwelingen HC, Rosendaal FR. Travel-related venous thrombosis: results from a large population-based case control study (MEGA study). PLoS Med 2006; 3:e307.
  29. McQuillan AD, Eikelboom JW, Baker RI. Venous thromboembolism in travellers: can we identify those at risk? Blood Coagul Fibrinolysis 2003; 14:671.
  30. Rege KP, Bevan DH, Chitolie A, Shannon MS. Risk factors and thrombosis after airline flight. Thromb Haemost 1999; 81:995.
  31. Schreijer AJ, Cannegieter SC, Doggen CJ, Rosendaal FR. The effect of flight-related behaviour on the risk of venous thrombosis after air travel. Br J Haematol 2009; 144:425.
  32. Schreijer AJ, Cannegieter SC, Meijers JC, et al. Activation of coagulation system during air travel: a crossover study. Lancet 2006; 367:832.
  33. Kuipers S, Cannegieter SC, Doggen CJ, Rosendaal FR. Effect of elevated levels of coagulation factors on the risk of venous thrombosis in long-distance travelers. Blood 2009; 113:2064.
  34. Lapostolle F, Le Toumelin P, Chassery C, et al. Gender as a risk factor for pulmonary embolism after air travel. Thromb Haemost 2009; 102:1165.
  35. Delis KT, Knaggs AL, Sonecha TN, et al. Lower limb venous haemodynamic impairment on dependency: quantification and implications for the "economy class" position. Thromb Haemost 2004; 91:941.
  36. Bärtsch P, Straub PW, Haeberli A. Hypobaric hypoxia. Lancet 2001; 357:955.
  37. Schreijer AJ, Hoylaerts MF, Meijers JC, et al. Explanations for coagulation activation after air travel. J Thromb Haemost 2010; 8:971.
  38. Boccalon H, Boneu B, Emmerich J, et al. Long-haul flights do not activate hemostasis in young healthy men. J Thromb Haemost 2005; 3:1539.
  39. Toff WD, Jones CI, Ford I, et al. Effect of hypobaric hypoxia, simulating conditions during long-haul air travel, on coagulation, fibrinolysis, platelet function, and endothelial activation. JAMA 2006; 295:2251.
  40. Kahn SR, Lim W, Dunn AS, et al. Prevention of VTE in nonsurgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141:e195S.
  41. Clarke MJ, Broderick C, Hopewell S, et al. Compression stockings for preventing deep vein thrombosis in airline passengers. Cochrane Database Syst Rev 2016; 9:CD004002.
  42. Cesarone MR, Belcaro G, Nicolaides AN, et al. Venous thrombosis from air travel: the LONFLIT3 study--prevention with aspirin vs low-molecular-weight heparin (LMWH) in high-risk subjects: a randomized trial. Angiology 2002; 53:1.
  43. Ball ST, Pinsorsnak P, Amstutz HC, Schmalzried TP. Extended travel after hip arthroplasty surgery. Is it safe? J Arthroplasty 2007; 22:29.