From the Guidelines
Patients with pulmonary embolism (PE) should avoid air travel until they are stable and adequately treated, typically for at least 2-4 weeks after diagnosis, and then take precautions such as staying hydrated, performing leg exercises, and wearing compression stockings to minimize the risk of clot formation or extension. According to a recent study published in Nature Reviews Cardiology 1, the risk of deep venous thrombosis (DVT) and pulmonary embolism is increased during travel that is >4 hours in duration, most probably owing to the associated immobility.
Some key precautions for patients with PE to take when traveling by plane include:
- Staying well-hydrated by drinking plenty of water and avoiding alcohol and caffeine
- Performing regular leg exercises such as ankle circles, calf raises, and walking the aisle every 1-2 hours to prevent blood stasis
- Wearing compression stockings (15-30 mmHg) to improve circulation
- Continuing their prescribed anticoagulation medication without interruption, whether it's a direct oral anticoagulant (DOAC) or warfarin with a stable INR between 2-3
- Carrying medical documentation about their condition and medication, knowing the location of medical facilities at their destination, and having sufficient medication for the entire trip plus extra in case of delays.
It is essential for patients with PE to consult their healthcare provider before traveling to ensure they are medically cleared for air travel and to discuss any specific precautions or concerns they may have 1. The overall absolute incidence of symptomatic venous thromboembolism (VTE) in healthy individuals within the first month after a flight lasting >4 hours is approximately 1 in 4,600 flights, and this risk increases by 18% for each additional 2 hours in flight duration 1.
From the Research
Risks of Flying with Pulmonary Embolism
- The risk of flying after being diagnosed with pulmonary embolism is not the same for all patients and depends on the risk stratification on presentation and the PaO2 level 2.
- Patients with pulmonary embolism should be assessed individually to determine their fitness to fly.
Precautions for Flying with Pulmonary Embolism
- The decision to fly should take into consideration the risk of recurrence and the individual risk of bleeding 3.
- Patients with high or intermediate clinical probability of pulmonary embolism should be treated with anticoagulation without delay while awaiting the results of diagnostic tests 3.
- Low-molecular-weight heparin (LMWH) and fondaparinux are preferred over unfractionated heparin (UFH) in the initial anticoagulation of PE since they are associated with a lower risk of bleeding 3, 4.
Anticoagulation Therapy for Pulmonary Embolism
- Anticoagulation therapy is recommended for preventing, treating, and reducing the recurrence of venous thromboembolism, including pulmonary embolism 5.
- Direct oral anticoagulants are first-line agents for eligible patients for treating venous thromboembolism, including pulmonary embolism 5.
- Vitamin K antagonists are recommended for patients with mechanical valves and valvular atrial fibrillation 5.
Outpatient Management of Pulmonary Embolism
- Outpatient treatment with LMWH has been shown to be feasible in many patients, and offers the potential for cost-savings and improvements in health-related quality of life 4.
- Select patients at low risk can initiate treatment in the outpatient setting for venous thromboembolism, including pulmonary embolism, with direct oral anticoagulants 5.