Skip to main content
Log in

Air travel and the risk of thromboembolism

  • IM - Review
  • Published:
Internal and Emergency Medicine Aims and scope Submit manuscript

Abstract

Almost two billion people use commercial aircraft annually. Long-haul flights are taken by over 300 million people. A serious complication of long-distance travel (or prolonged time of flight) is thromboembolism. The real incidence of the problem is difficult to evaluate since there is no consensus about the diagnostic tests or limitation of time after landing connected to the VTE complication. A direct relation between VTE incidence and long-distance flights has been documented. The risk for DVT is 3–12% in a long-haul flight. The pathophysiologic changes that increase VTE risk at flight are stasis (sitting in crowded condition), hypoxia in the airplane cabin, and dehydration. Individual risk factors for air travel-related VTE include age over 40 years, gender (female), women who use oral contraceptives, varicose veins in lower limbs, obesity and genetic thrombophilia. Prevention measures include environmental protection such as keeping the pressure inside the airplane cabinet in hypobaric condition, avoiding dehydration and prolonged sitting. For individuals at increased risk, venous blood stasis can be reduced by wearing elastic stockings and prophylactic use of low-molecular-weight heparin.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Silverman D, Gendreau M (2009) Medical issues associated with commercial flights. Lancet 373(9680):2067–2077

    Article  PubMed  Google Scholar 

  2. Brenner B (2009) Prophylaxis of travel-related thrombosis in women. Thromb Res 123(Suppl 3):S26–S29

    Article  PubMed  CAS  Google Scholar 

  3. Philbrick JT, Shumate R, Siadaty MS et al (2007) Air travel and venous thromboembolism: a systematic review. J Gen Intern Med 22:107–114

    Article  PubMed  Google Scholar 

  4. Chandra D, Parini E, Mozaffarian D (2009) Meta-analysis: travel and risk for venous thromboembolism. Ann Intern Med 151:180–190

    PubMed  Google Scholar 

  5. Lapostolle F, Surget V, Borron SW et al (2001) Severe pulmonary embolism associated with air travel. N Engl J Med 345:779–783

    Article  PubMed  CAS  Google Scholar 

  6. Perez-Rodriguez E, Jiménez D, Díaz G et al (2003) Incidence of air travel-related pulmonary embolism at the Madrid-Barajas airport. Arch Intern Med 163:2766–2770

    Article  PubMed  Google Scholar 

  7. Kline JA, Putman M, Courtny DM (2002) Fatal pulmonary embolism immediately aftertransatlantic air travel to USA: less than one in a million. Throm Haemost 87(2):342

    CAS  Google Scholar 

  8. Kelman C, Kortt MA, Becker NG et al (2003) Deep vein thrombosis and air travel: record linkage study. BMJ 327:1072

    Article  PubMed  CAS  Google Scholar 

  9. Schwarz T, Siegert G, Oettler W et al (2003) Venous thrombosis after long-haul flights. Arch Intern Med 163:2759–2764

    Article  PubMed  Google Scholar 

  10. Scurr JH, Machin SJ, Bailey-King S et al (2001) Frequency and prevention of symptomless deep-vein thrombosis in long-haul flights: a randomised trial. Lancet 357:1485–1489

    Article  PubMed  CAS  Google Scholar 

  11. Huges RJ, Hopkins RJ, Hill S et al (2003) Frequency of venous thromboembolism in low to moderate risk long distance air travelers: the New Zealand Air Travelers Thrombosis (NZAIT) study. Lancet 362:2039–2044

    Article  Google Scholar 

  12. Belcaro G, Geroulakos G, Nicolaides AN et al (2001) Venous thromboembolism from air travel: the LONFLIT study. Angiology 52:369–374

    Article  PubMed  CAS  Google Scholar 

  13. Martinelli I, Taioli E, Battaglioli T et al (2003) Risk of venous thromboembolism after air travel: interaction with thrombophilia and oral contraceptives. Arch Intern Med 16:2771–2774

    Article  Google Scholar 

  14. Cannegieter SC, Doggen CJ, van Houwelingen HC et al (2006) Travel-related venous thrombosis: results from a large population-based case control study (MEGA study). PLoS Med 3:e307

    Article  PubMed  Google Scholar 

  15. Mohr LC (2008) Hypoxia during air travel in adults with pulmonary disease. Am J Med Sci 335:71–79

    Article  PubMed  Google Scholar 

  16. Schreijer AJ, Cannegieter SC, Meijers JC et al (2006) Activation of coagulation system during air travel: a crossover study. Lancet 367:832–838

    Article  PubMed  CAS  Google Scholar 

  17. Bendz B, Rostrup M, Sevre K et al (2000) Association between acute hypobaric hypoxia and activation of coagulation in human beings. Lancet 356:832–838

    Article  Google Scholar 

  18. Masoud M, Sarig G, Brenner B, Jacob G (2008) Orthostatic hypercoagulability: a novel physiological mechanism to activate the coagulation system. Hypertension 51:1545–1551

    Article  PubMed  CAS  Google Scholar 

  19. Kuipers S, Cannegieter SC, Doggen CJM et al (2009) Effect of elevated levels of coagulation factors on risk of venous thrombosis in long-distance travelers. Blood 113(9):2064–2069

    Article  PubMed  CAS  Google Scholar 

  20. Chee YL, Watson HG (2005) Air travel and thrombosis. BJH 130:671–680

    Article  Google Scholar 

  21. Geerts WH, Bergqvist D, Pineo GF, American College of Chest Physicians et al (2008) Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 133(6 Suppl):381S–453S

    Article  PubMed  CAS  Google Scholar 

  22. Cesarone MR, Belcaro G, Nicolaides AN et al (2002) Venous thrombosis from air travel: the LONFLIT3 study–prevention with aspirin vs low-molecular-weight heparin (LMWH) in high-risk subjects: a randomized trial. Angiology 53:1–6

    Article  Google Scholar 

  23. Brenner B (2004) Prophylaxis for travel-related thrombosis? Yes. J ThrombHaemost 2:2089–2091

    CAS  Google Scholar 

  24. Ceasarone MR, Belcaro G, Errichi B et al (2003) The LONFLIT4- Concordedeep venous thrombosis and edema study: prevention with travel stockings. Angiology 54(2):143–154

    Article  Google Scholar 

  25. Lapostolle F, Le Toumellin P, Chassery M et al (2009) Gender as a risk factor for pulmonary embolism after air travel. Thromb Haemost 102(6):1165–1168

    PubMed  CAS  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Israel Gavish.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gavish, I., Brenner, B. Air travel and the risk of thromboembolism. Intern Emerg Med 6, 113–116 (2011). https://doi.org/10.1007/s11739-010-0474-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11739-010-0474-6

Keywords

Navigation