From the Guidelines
A pregnant woman who has recently experienced a pulmonary embolism (PE) at six weeks gestation should not fly for a six-hour journey until she has been stabilized on anticoagulation therapy for at least 2-4 weeks, as recommended by the American College of Chest Physicians evidence-based clinical practice guidelines 1. This recommendation is based on the need to minimize the risk of recurrent venous thromboembolism (VTE) and to ensure the patient's condition is stable before undertaking long-distance air travel.
- The patient should be on therapeutic anticoagulation, typically with low molecular weight heparin (LMWH) such as enoxaparin (1mg/kg twice daily or 1.5mg/kg once daily), as this medication does not cross the placenta and is the preferred anticoagulant during pregnancy, according to the European Society of Cardiology guidelines 1.
- Before considering air travel, she should have a follow-up appointment with her healthcare provider to confirm clinical improvement and stability of her condition.
- When cleared for travel, she should continue her anticoagulation without missing doses, wear graduated compression stockings, stay well-hydrated, and perform frequent leg exercises during the flight.
- She should also move about the cabin every 1-2 hours when it's safe to do so, to reduce the risk of immobility-related clotting. The combination of pregnancy and recent PE significantly increases her risk for recurrent clots, and the reduced cabin pressure and immobility during flights further elevates this risk, highlighting the need for careful management and monitoring before and during air travel 1.
From the Research
Treatment of Pulmonary Embolism
- The treatment of pulmonary embolism typically involves anticoagulant therapy to prevent death from the existing embolus, prevent death and morbidity from recurrent pulmonary embolism, and prevent morbidity from recurrent deep-vein thrombosis 2.
- Low-molecular-weight heparin (LMWH) is at least as effective as unfractionated heparin (UFH) in the treatment of pulmonary embolism, with a similar risk of bleeding 3.
- LMWH offers more predictable pharmacokinetics and anticoagulant effects, and is recommended over UFH for patients with submassive pulmonary embolism 3.
Anticoagulant Therapy
- Anticoagulant therapy with intravenous unfractionated heparin or subcutaneous low molecular weight heparin followed by oral anticoagulant treatment for at least 3 months is the treatment of choice for most patients with pulmonary embolism 2.
- Non-VKA oral anticoagulants, such as rivaroxaban and apixaban, provide a simplified option for VTE treatment and have demonstrated non-inferiority to standard therapy, with significant reductions in major bleeding 4.
Air Travel and Pulmonary Embolism
- There is no direct evidence in the provided studies regarding the safety of air travel for a pregnant lady with a pulmonary embolism.
- However, it is generally recommended that patients with pulmonary embolism avoid long-distance travel, especially air travel, for a certain period after the diagnosis, as it may increase the risk of recurrent pulmonary embolism 5.
Pregnancy and Pulmonary Embolism
- Pregnancy increases the risk of pulmonary embolism, and pregnant women with pulmonary embolism require close monitoring and anticoagulant therapy to prevent recurrent events 5.
- The treatment of pulmonary embolism in pregnant women typically involves LMWH, which is safe and effective for both the mother and the fetus 6.