Prevention of venous thromboembolism in adult travelers
- Menaka Pai, MD, FRCPC
Menaka Pai, MD, FRCPC
- Associate Professor, Hematology and Thromboembolism
- McMaster University
- James D Douketis, MD, FRCPC, FACP, FCCP
James D Douketis, MD, FRCPC, FACP, FCCP
- Professor, Department of Medicine
- McMaster University
- Section Editors
- Lawrence LK Leung, MD
Lawrence LK Leung, MD
- Editor-in-Chief — Hematology
- Section Editor — Disorders of Hemostasis and Coagulation
- Professor of Medicine
- Stanford University School of Medicine
- Jess Mandel, MD
Jess Mandel, MD
- Section Editor — Pulmonary Vascular Disease
- Professor of Medicine
- University of California, San Diego
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 conferred by prolonged 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) . 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 .
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