HNY Policy and Pathway Repository - North Yorkshire

Although the risk of venous thrombosis is approximately doubled by long-haul travel (>4 hours), the absolute risk remains low for most people (approximately one event per 4500-6000 people). The increased risk is present regardless of the mode of travel, and it is uncertain if air travel confers any additional risk.

High risk:

• Active malignancy untreated or on active treatment
• Pregnancy or hormone treatment (e.g. OCP, HRT) and BMI >30 kg/m 2
• Within 6 weeks post-partum
• Major surgery (anaesthesia >30 minutes) within past 4 weeks (potentially 3 months for hir or knee replacement surgery).
• Significant immobility
• Previous unprovoked or travel related VTE and not taking anticoagulation

Management:

All people: General advice includes avoiding prolonged immobility (recline seat when possible, loose clothing, calf / leg exercises when sitting, short walks or breaks when possible), maintaining a normal fluid intake and avoiding alcohol or sedatives.

High risk:

• Avoid non-essential travel if possible
• Consider class 1 compression stockings or propriety flight socks (unless ABPI <0.8).
• Consider LMWH (would need prophylactic dose for outbound and return flights, instruction on use & storage, sharps bin, and letter for customs / security).

Class 1 stockings should provide 14-17mmHg compression at the ankle. Not available on prescription for VTE prevention (class 1 can be prescribed for varicose veins). Propriety flight socks widely available.

Aspirin (either commencing aspirin or increasing the dose if already using) is not recommended for VTE prevention during travel.

None provided

References

NICE Clinical Knowledge Summary. DVT Prevention for Travellers (November 2023). https://cks.nice.org.uk/dvt-prevention-for-travellers 

• South Tees Hospitals