Venous Thromboembolism Following Travel

Authors

1 Health Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran

2 Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran

3 Department of Cardiology, Baqiyatallah University of Medical Sciences, Tehran, Iran

Abstract

International travel has become increasingly common and accessible, hence, about two billion passengers undertake international and domestic air travel each year. Venous thromboembolism (VTE) is a serious public health disorder which may occur following prolonged travel, especially after air travel. A direct relation between VTE development and prolonged travels has been documented, while some references did not confirm this relation. The travel-related VTE is a multi-factorial disorder, and the risk of thrombosis is higher in individuals with pre-existing risk factors. Some believe that hypobaric hypoxia was a more likely explanation for thrombus formation during prolonged travel. Other factors including immobilization, dehydration, excessive alcohol or coffee consumption, lower air pressure, and lower humidity can make the traveler prone to thrombus formation. Herein we tried to evaluate previous studies and available guidelines thereby providing information on the association of thrombosis and travel, risk factors, risk assessment, and strategies for the prevention of VTE following travel.

Keywords


Izadi M. Travel medicine: a country-to-country guide. 1th ed: NOVA; 2013.
Izadi M. Medical guideline for international travel medicine: Helal institute of applied sciences and technology publication; 2009.
IPK International. Global travel trends 2010/2011.   [2011 Aug 22]; Available from: http://www.ipkinternational.­com/uploads/media/IPK.
Gendreau MA, DeJohn C. Responding to medical events during commercial airline flights. N Engl J Med. 2002;346(14):1067-73. PubMed PMID: 11932475
Ryan ET, Kain KC. Health advice and immunizations for travelers. N Engl J Med. 2000;342(23):1716-25. PubMed PMID: 10841875
Homans J. Thrombosis of the deep leg veins due to prolonged sitting. The New England journal of medicine. 1954;250(4):148. PubMed PMID: 13119864
Partsch H, Niessner H, Bergau L, Blättler W, Cerny J, Gerlach H, et al. Traveller’s thrombosis 2001. Vasa. 2002;31(1):66-7. PubMed PMID: 11951702
Schobersberger W, Toff W, Eklöf B, Fraedrich G, Gunga H, Haas S, et al. Traveller’s thrombosis: International consensus statement. Vasa. 2008;37(4):311-7. PubMed PMID: 19003740
Watson HG, Baglin TP. Guidelines on travelā€related venous thrombosis. Br J haematol. 2011;152(1):31-4. PubMed PMID: 21083651
Mendis S, Yach D, Alwan A. Air travel and venous thromboembolism. Bulletin of the World Health Organization. 2002;80(5):403-6. PubMed PMID: 12077617
World Health Organization. The WRIGHT Project: World Health Organization Research into Global Hazards of Travel. Geneva, Switzerland: WHO Press, 2007.
Rosendaal F. Venous thrombosis: a multicausal disease. The Lancet. 1999;353(9159):1167-73. PubMed PMID: 10209995
Scurr JH, Machin SJ, Bailey-King S, Mackie IJ, McDonald S, Smith PDC. Frequency and prevention of symptomless deep-vein thrombosis in long-haul flights: a randomised trial. The Lancet. 2001;357(9267):1485-9. PubMed PMID: 11377600
Schwarz T, Siegert G, Oettler W, Halbritter K, Beyer J, Frommhold R, et al. Venous thrombosis after long-haul flights. Archives of internal medicine. 2003;163(22):2759-64. PubMed PMID: 14662630
Schindler O, Dalziel R. Post-thrombotic syndrome after total hip or knee arthroplasty: incidence in patients with asymptomatic deep venous thrombosis. Journal of Orthopaedic Surgery. 2005;13(2):113-9. PubMed PMID: 16131671
Vaitkus PT, Leizorovicz A, Cohen AT, Turpie A, Olsson C-G, Goldhaber SZ. Mortality rates and risk factors for asymptomatic deep vein thrombosis in medical patients. Thrombosis and haemostasis. 2005;93(1):76-9. PubMed PMID: 15630494
Gary T, Belaj K, Steidl K, Pichler M, Eisner F, Stöger H, et al. Asymptomatic deep vein thrombosis and superficial vein thrombosis in ambulatory cancer patients: impact on short-term survival. British journal of cancer. 2012;107(8):1244-8. PubMed PMID: 22968652
Quinlan D, Eikelboom J, Dahl O, Eriksson BI, Sidhu P, Hirsh J. Association between asymptomatic deep vein thrombosis detected by venography and symptomatic venous thromboembolism in patients undergoing elective hip or knee surgery. J Thromb & Haemost. 2007;5(7):1438-43. PubMed PMID: 17425687
Perez-Rodriguez E, Jiménez D, Diaz G, Pérez-Walton I, Luque M, Guillén C, et al. Incidence of air travel-related pulmonary embolism at the Madrid-Barajas airport. Archives of internal medicine. 2003;163(22):2766-70. PubMed PMID: 14662631
Lapostolle F, Surget V, Borron SW, Desmaizières M, Sordelet D, Lapandry C, et al. Severe pulmonary embolism associated with air travel. New England Journal of Medicine. 2001;345(11):779-83. PubMed PMID: 11556296
Kuipers S, Cannegieter SC, Middeldorp S, Robyn L, Büller HR, Rosendaal FR. The absolute risk of venous thrombosis after air travel: a cohort study of 8,755 employees of international organisations. PLoS medicine. 2007;4(9):e290. PubMed PMID: 17896862
Adi Y, Bayliss S, Rouse A, Taylor R. The association between air travel and deep vein thrombosis: Systematic review & meta-analysis. BMC Cardiovascular disorders. 2004;4(1):7. PubMed PMID: 15151705
Kuipers S, Schreijer A, Cannegieter S, Büller H, Rosendaal F, Middeldorp S. Travel and venous thrombosis: a systematic review. Journal of internal medicine. 2007;262(6):615-34. PubMed PMID: 18028182
Chandra D, Parisini E, Mozaffarian D. Meta-analysis: travel and risk for venous thromboembolism. Annals of internal medicine. 2009;151(3):180-90. PubMed PMID: 19581633
Chee YL, Watson H. Air travel and thrombosis. British journal of haematology. 2005;130(5):671-80. PubMed PMID: 16115122
Ansari MT, Cheung BM, Qing Huang J, Eklof B, Karlberg JP. Traveler's Thrombosis: A Systematic Review. Journal of travel medicine. 2005;12(3):142-54. PubMed PMID: 15996443
Philbrick JT, Shumate R, Siadaty MS, Becker DM. Air travel and venous thromboembolism: a systematic review. Journal of general internal medicine. 2007;22(1):107-14. PubMed PMID: 17351849
Trujillo-Santos AJ, Jiménez-Puente A, Perea-Milla E. Association between long travel and venous thromboembolic disease: a systematic review and meta-analysis of case-control studies. Annals of hematology. 2008;87(2):79-86. PubMed PMID: 17899081
Goldhaber SZ. Risk factors for venous thromboembolism. Journal of the American College of Cardiology. 2010;56(1):1-7. PubMed PMID: 20620709
Anderson FA, Spencer FA. Risk factors for venous thromboembolism. Circulation. 2003;107(23 suppl 1):I-9-I-16. PubMed PMID: 12814980
Bartholomew JR, Schaffer JL, McCORMICK GF. Air travel and venous thromboembolism: Minimizing the risk. Cleveland Clinic Journal of Medicine. 2011;78(2):111-20. PubMed PMID: 21285343
Lapostolle F, Le Toumelin P, Chassery C, Galinski M, Ameur L, Jabre P, et al. Gender as a risk factor for pulmonary embolism after air travel. Thromb Haemost. 2009;102(6):1165-8. PubMed PMID: 19967147
Pomp E, Lenselink A, Rosendaal F, Doggen C. Pregnancy, the postpartum period and prothrombotic defects: risk of venous thrombosis in the MEGA study. Journal of Thrombosis and Haemostasis. 2008;6(4):632-7. PubMed PMID: 18248600
Cannegieter SC, Rosendaal FR. Pregnancy and travel-related thromboembolism. Thrombosis Research. 2013;131:S55-S8. PubMed PMID: 23452744
Arfvidsson B, Eklof B, Kistner RL, Masuda EM, Sato D. Risk factors for venous thromboembolism following prolonged air travel: a “prospective” study. Vasc Surg. 1999;33:537-44.
Hosoi Y, Geroulakos G, Belcaro G, Sutton S. Characteristics of deep vein thrombosis associated with prolonged travel. European journal of vascular and endovascular surgery. 2002;24(3):235-8. PubMed PMID: 12217285
Martinelli I, Taioli E, Battaglioli T, Podda GM, Passamonti SM, Pedotti P, et al. Risk of venous thromboembolism after air travel: interaction with thrombophilia and oral contraceptives. Archives of internal medicine. 2003;163(22):2771. PubMed PMID: 14662632
Schreijer A, Cannegieter S, Meijers J, Middeldorp S, Büller H, Rosendaal F. Activation of coagulation system during air travel: a crossover study. The Lancet. 2006;367(9513):832-8. PubMed PMID: 16530577
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 medicine. 2006;3(8):e307. PubMed PMID: 16933962
Sándor T. Travel thrombosis: pathomechanisms and clinical aspects. Pathophysiology. 2008;15(4):243-52. PubMed PMID: 19019640
Cannegieter SC. Travel-related thrombosis. Best Practice & Research Clinical Haematology. 2012;25(3):345-50.
O'Keeffe D, Baglin T. Travellers’ thrombosis and economy class syndrome: incidence, aetiology and prevention. Clinical & Laboratory Haematology. 2003;25(5):277-81. PubMed PMID: 12974716
Wright HP, Osborn S. Effect of posture on venous velocity, measured with 24NaCl. British Heart Journal. 1952;14(3):325. PubMed PMID: 14944721
Bauer KA, Rosenberg RD. The pathophysiology of the prethrombotic state in humans: insights gained from studies using markers of hemostatic system activation. Blood. 1987;70(2):343-50. PubMed PMID: 3607275
Stricker H, Colucci G, Godio M, Mossi G, Mombelli G. The influence of a prolonged sitting position on the biochemical markers of coagulation activation in healthy subjects: evidence of reduced thrombin generation. Journal of Thrombosis and Haemostasis. 2003;1(2):380-1. PubMed PMID: 12871514
Schobersberger W, Mittermayr M, Innerhofer P, Sumann G, Schobersberger B, Klingler A, et al. Coagulation changes and edema formation during long-distance bus travel. Blood coagulation & fibrinolysis. 2004;15(5):419-25. PubMed PMID: 15205591
House of Lords. Air Travel and Health: an Update. Report and Evidence. The Stationery Office Ltd., London, 2007.
Bagshaw M, MFOM D. Traveller's thrombosis: a review of deep vein thrombosis associated with travel. Aviation, space, and environmental medicine. 2001;72(9):848-51. PubMed PMID: 11565823
Bendz B, Rostrup M, Sevre K, Andersen TO, Sandset PM. Association between acute hypobaric hypoxia and activation of coagulation in human beings. The Lancet. 2000;356(9242):1657-8. PubMed PMID: 11089830
Simons R, Krol J. Jet leg, pulmonary embolism, and hypoxia. The Lancet. 1996;348(9024):416. PubMed PMID: 8709773
Humphreys S, Deyermond R, Bali I, Stevenson M, Fee J. The effect of high altitude commercial air travel on oxygen saturation. Anaesthesia. 2005;60(5):458-60. PubMed PMID: 15819766
Maher JT, Levine PH, Cymerman A. Human coagulation abnormalities during acute exposure to hypobaric hypoxia. Journal of applied physiology. 1976;41(5):702-7. PubMed PMID: 993158
Gertler JP, Perry L, L'Italien G, Chung-Welch N, Cambria RP, Orkin R, et al. Ambient oxygen tension modulates endothelial fibrinolysis. Journal of vascular surgery. 1993;18(6):939-46. PubMed PMID: 8264050
Schreijer A, Hoylaerts M, Meijers J, Lijnen H, Middeldorp S, Büller H, et al. Explanations for coagulation activation after air travel. Journal of Thrombosis and Haemostasis. 2010;8(5):971-8. PubMed PMID: 20175869
Mackman N. New insights into the mechanisms of venous thrombosis. The Journal of clinical investigation. 2012;122(7):2331-6. PubMed PMID: 22751108.
HODGSON M. Low relative humidity and aircraft cabin air quality. Indoor Air. 2001;11(3):200-14. PubMed PMID: 11521505
Landgraf H, Vanselow B, Schulte-Huermann D, Mülmann M, Bergau L. Economy class syndrome: rheology, fluid balance, and lower leg edema during a simulated 12-hour long distance flight. Aviation, space, and environmental medicine. 1994;65(10 Pt 1):930-5. PubMed PMID: 7832736
Nicholson A. Dehydration and long haul flights? Travel Medicine International. 1998;16:177-81.
Gavish I, Brenner B. Air travel and the risk of thromboembolism. Internal and emergency medicine. 2011;6(2):113-6. PubMed PMID: 21057984
Shrikrishna D, Coker RK. Managing passengers with stable respiratory disease planning air travel: British Thoracic Society recommendations. Thorax. 2011;66(9):831-3. PubMed PMID: 21807654
Kahn SR, Lim W, Dunn AS, Cushman M, Dentali F, Akl EA, et al. Prevention of VTE in Nonsurgical PatientsPrevention of VTE in Nonsurgical PatientsAntithrombotic Therapy and Prevention of Thrombosis: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. CHEST Journal. 2012;141(2_suppl):e195S-e226S. PubMed PMID: 22315261
Bendz B, Sevre K, Andersen T, Sandset P. Low molecular weight heparin prevents activation of coagulation in a hypobaric environment. Blood coagulation & fibrinolysis. 2001;12(5):371-4. PubMed PMID: 11505080