Prevention of venous thromboembolism on long-haul flights

Abstract

Objective: Venous thromboembolism (VTE) can result in significant morbidity and mortality. Air travel can triple the risk of VTE. Family doctors can play a role in the prevention of this problem. The aim of this study was to review the evidence for prevention of thromboembolism on long-haul flights. Data sources: MEDLINE, National Guideline Clearinghouse, Guidelines Finder, Canadian Medical Association Practice Guidelines Infobase, Scottish Intercollegiate Guidelines, The Cochrane Library, Clinical Evidence, DARE, Bandolier, Direção-Geral da Saúde and Sociedade Portuguesa de Medicina Interna. Revision methods: Guidelines, systematic reviews (SR), meta-analyses and original studies published between 2004 and 2014 were surveyed, using the keywords ‘venous thrombosis’, ‘prevention and control’ and ‘air travel’. To evaluate the levels of evidence and strength of recommendations, the Strength of Recommendation Taxonomy (SORT) scale of American Academy of Family Physicians was used. Results: Among the 121 articles found, 12 were selected including seven guidelines and five systematic reviews. Most articles stress the importance of individualized assessment of the risk of VTE before air travel. General measures are recommended for most of the population (SORT C). Elastic compression stockings should be used in people with risk factors and previous VTE (SORT B). Pharmacological prophylaxis can be reserved for high risk patients using low molecular weight heparin (SORT C). The use of aspirin is not recommended (SORT B). Conclusions: The findings are limited by the methodology of the studies, as well as by the population to which the results are applied. Until methodologically adequate studies are available, the decision regarding prophylaxis of VTE on long trips must be considered on an individual basis.