Other Health Issues
Venous thromboembolism (VTE)
The following advice is provided for medical practitioners who may be consulted about the risk of Venous Thromboembolism (VTE) associated with international (long-haul) air travel.
Fact Sheet - Health Advice to Medical Practitioners
Chief Medical OfficerThe following advice is provided for medical practitioners who may be consulted about the risk of Venous Thromboembolism (VTE) associated with international (long-haul) air travel:
Recent research findings
- A recent study conducted by the Commonwealth Department of Health and Ageing, with Australian experts, will be reported in the British Medical Journal. The study shows a temporary increase in the risk of VTE following long-haul air travel. The average risk of a VTE event was increased four-fold over the individual's baseline risk, but only for the period of two weeks immediately after travel. For a person making one long haul flight per year, this translates into a 12% increase in annual risk. Thus the risk remains very low for the majority of travellers.
- An earlier study of passengers arriving at Charles DeGaulle Airport in Paris showed that the risk of pulmonary embolism (PE) increased significantly for passengers travelling on flights greater than 5,000 km.1
1. Lapostolle F, N Engl J Med 2001;345:779-783.
Interpretation
- For most persons, the baseline risk of a VTE event is very low. The average VTE risk for a middle-aged traveller is about one per 40,000 flights, with a risk of death from flight-related PE after an overseas trip of about one in every 2 million flights. For a traveller taking one overseas trip per year, this means that the annual risk of death from flight-related VTE is some 100 times less than the average annual risk of death from a motor vehicle accident in Australia.
Risk Management
- The baseline risk of VTE is likely to be higher for intending travellers who are obese, for smokers, for those who have a past history of VTE, recent surgery or a concurrent illness, and for the small number with a predisposition to blood clots in the family. A list of known risk factors for VTE is included in Box 1.
- Older individuals also have a somewhat greater baseline risk.
- Persons with a greater baseline risk of VTE are also likely to be at greater risk of VTE following air travel.
- The Australian airline industry already provides in-flight preventive recommendations to airline passengers. These include regular leg and calf exercise, adequate hydration and avoidance of sedatives including alcohol. The evidence base for these measures is incomplete. Nevertheless, the advice should be supported.
- There is limited evidence for the benefit of using compressive stockings in the higher risk groups. To be effective, stockings must be properly fitted.
- There is no direct evidence of a prophylactic effect for aspirin in travel-related VTE.
- Specialist referral may be appropriate for those with a family history or past history of VTE or thrombosis, for those with other predisposing conditions, or if low molecular weight heparin prophylaxis is contemplated.
Information sources for travellers
Some useful web-sites are included below.
Department of Health and Ageinghttp://www.health.gov.au/internet/main/publishing.nsf/Content/health-pubhlth-strateg-communic-factsheets-thrombosis.htm
Department of Foreign Affairs and Trade
http://www.smartraveller.gov.au
Civil Aviation Safety Authority
http://www.casa.gov.au/airsafe/trip/index.htm
Box 1: Risk factors for VTE
Thrombophilias
|
Australian Chief Medical Officer
November, 2003
For further information contact:
Office of Health Protection
Phone 02 6289 1555
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