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Journal of General Internal Medicine

, Volume 22, Issue 1, pp 107–114 | Cite as

Air Travel and Venous Thromboembolism: A Systematic Review

  • John T. PhilbrickEmail author
  • Rebecca Shumate
  • Mir S. Siadaty
  • Daniel M. Becker
Original Article

Context

Despite multiple attempts to document and quantify the danger of venous thromboembolism (VTE) following prolonged travel, there is still uncertainty about the magnitude of risk and what can be done to lower it.

Objectives

To review the methodologic strength of the literature, estimate the risk of travel-related VTE, evaluate the efficacy of preventive treatments, and develop evidence-based recommendations for practice.

Data Sources

Studies identified from MEDLINE from 1966 through December 2005, supplemented by a review of the Cochrane Central Registry of Controlled Trials, the Database of Abstracts of Reviews of Effects, and relevant bibliographies.

Study Selection

We included all clinical studies that either reported primary data concerning travel as a risk factor for VTE or tested preventive measures for travel-related VTE.

Data Extraction and Analysis

Two reviewers reviewed each study independently to assess inclusion criteria, classify research design, and rate methodologic features. The effect of methodologic differences, VTE risk, and travel duration on VTE rate was evaluated using a logistic regression model.

Data Synthesis

Twenty-four published reports, totaling 25 studies, met inclusion criteria (6 case-control studies, 10 cohort studies, and 9 randomized controlled trials). Method of screening for VTE [screening ultrasound compared to usual clinical care, odds ratio (OR) 390], outcome measure [all VTE compared to pulmonary embolism (PE) only, OR 21], duration of travel (<6 hours compared to 6–8 hours, OR 0.011), and clinical risk (“higher” risk travelers compared to “lower,” OR 3.6) were significantly related to VTE rate. Clinical VTE after prolonged travel is rare [27 PE per million flights diagnosed through usual clinical care, 0.05% symptomatic deep venous thrombosis (DVT) diagnosed through screening ultrasounds], but asymptomatic thrombi of uncertain clinical significance are more common. Graduated compression stockings prevented travel-related VTE (P < 0.05 in 4 of 6 studies), aspirin did not, and low-molecular-weight heparin (LMWH) showed a trend toward efficacy in one study.

Conclusions

All travelers, regardless of VTE risk, should avoid dehydration and frequently exercise leg muscles. Travelers on a flight of less than 6 hours and those with no known risk factors for VTE, regardless of the duration of the flight, do not need DVT prophylaxis. Travelers with 1 or more risk factors for VTE should consider graduated compression stockings and/or LMWH for flights longer than 6 hours.

Key words

venous thromboembolism deep venous thrombosis pulmonary embolism air travel transportation systematic review 

Notes

Potential Financial Conflicts of Interest

None disclosed.

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Copyright information

© Society of General Internal Medicine 2007

Authors and Affiliations

  • John T. Philbrick
    • 1
    • 2
    • 3
    Email author
  • Rebecca Shumate
    • 1
  • Mir S. Siadaty
    • 2
  • Daniel M. Becker
    • 1
    • 2
  1. 1.Department of Internal MedicineUniversity of Virginia School of MedicineCharlottesvilleUSA
  2. 2.Department of Public Health SciencesUniversity of Virginia School of MedicineCharlottesvilleUSA
  3. 3.University of Virginia Health Sciences CenterCharlottesvilleUSA

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