From the Guidelines
Flying is generally safe for a patient who had a percutaneous coronary intervention (PCI) approximately 14 days ago, provided there are no complications from the procedure and dual antiplatelet therapy is continued. According to the acc/aha 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery 1, the management of patients with previous PCI who require non-cardiac surgery or other procedures, such as flying, should be based on the type of stent used and the time since PCI.
Key Considerations
- The type of stent used (bare-metal or drug-eluting) and the time since PCI are crucial in determining the safety of flying.
- For patients with a bare-metal stent, the recommended delay for elective or nonurgent surgery is less than 30-45 days, but for flying, this timeframe may be shorter.
- The guidelines suggest that clinicians should remain vigilant even beyond 365 days after drug-eluting stent (DES) placement due to the risk of late DES thrombosis.
Recommendations
- Patients should continue taking all prescribed medications, particularly dual antiplatelet therapy, without interruption during their trip 1.
- It is essential to consult with your cardiologist before making travel plans to ensure that you are stable enough for air travel.
- During the flight, stay well-hydrated, move your legs periodically, and consider compression stockings for flights longer than 4 hours to prevent blood clots.
Risks and Precautions
- The main concern after PCI is stent thrombosis, which becomes less likely after the first week as the stent begins to endothelialize.
- The reduced oxygen and cabin pressure during flights typically doesn't pose significant risks to patients with stable coronary artery disease after successful PCI.
- However, it is crucial to weigh the risk of stopping antiplatelet therapy against the benefit of reduction in bleeding complications from the planned surgery or procedure, such as flying 1.
From the Research
Safety of Flying after PCI
The safety of flying after percutaneous coronary intervention (PCI) is a concern for patients and healthcare providers. While the provided studies do not directly address the safety of flying after PCI, they do discuss the risks and benefits of different antiplatelet therapy strategies after PCI.
Antiplatelet Therapy after PCI
- The studies suggest that P2Y12 inhibitor monotherapy after a short course of dual antiplatelet therapy (DAPT) may be a safe and effective strategy for reducing the risk of bleeding without increasing the risk of thrombotic complications 2, 3, 4, 5.
- One study found that clopidogrel monotherapy was associated with a lower risk of death, myocardial infarction, and stroke compared to aspirin monotherapy in patients at high risk of recurrent ischemic events after PCI 6.
Considerations for Flying after PCI
- While there is no direct evidence on the safety of flying after PCI, patients who have undergone PCI are generally considered to be at higher risk for cardiovascular events, especially in the first few weeks after the procedure.
- The risk of bleeding and thrombotic complications may be higher in the first few weeks after PCI, and patients should be carefully evaluated before flying.
- Patients who have undergone PCI should follow their healthcare provider's recommendations for antiplatelet therapy and lifestyle modifications to reduce their risk of cardiovascular events.
Key Findings
- P2Y12 inhibitor monotherapy may be a safe and effective strategy for reducing the risk of bleeding after PCI 2, 3, 4, 5.
- Clopidogrel monotherapy may be associated with a lower risk of death, myocardial infarction, and stroke compared to aspirin monotherapy in patients at high risk of recurrent ischemic events after PCI 6.
- Patients who have undergone PCI should be carefully evaluated before flying, and should follow their healthcare provider's recommendations for antiplatelet therapy and lifestyle modifications to reduce their risk of cardiovascular events.