How to prevent venous thromboembolism (VTE) on long trips

The resurgence of travel is bringing questions about how to prevent venous thromboembolism (VTE) on long trips.

Long-haul flights are often thought of as the main culprit…but any trip (bus, car, etc) over 4 hours may increase VTE risk.

It’s rare…but as travel time increases, so does risk.

Get up and move around if possible…not to cross legs…and to do leg exercises (ankle circles, etc) regularly. Also stop every couple of hours on a road trip.

Staying hydrated and limiting alcohol make good sense…even though they’re not proven to prevent clots.

Sitting in business class doesn’t seem to lower VTE risk when flying…but sitting in an aisle seat may.

Suggest that at-risk patients…such as those with cancer, prior VTE, or who are pregnant…use below-the-knee compression stockings with 15 to 30 mm Hg of ankle pressure. These are the best bet of any preventive approach.

Don’t routinely recommend adding antithrombotics (anticoagulants, aspirin, etc).

You may see some high-risk patients, such as those with multiple risk factors, get prophylaxis with low-molecular-weight heparin (enoxaparin, etc) before a long flight. But data are scarce.

Educate travellers to report any signs or symptoms of VTE…leg pain or swelling, chest pain, shortness of breath, etc.

Caution that risk is greatest in the first 2 weeks after flying…but clot symptoms can occur even a couple months after travel.