Flying Long Distance While on Clopidogrel and Eliquis
Direct Recommendation
You should continue your current anticoagulation regimen (Eliquis and clopidogrel) without any additional pharmacologic prophylaxis, focus on mechanical prevention measures including frequent ambulation every 2 hours, calf muscle exercises, and consider wearing properly fitted below-knee compression stockings (15-30 mmHg at ankle) if you have additional VTE risk factors. 1
Why No Additional Anticoagulation is Needed
The American College of Chest Physicians explicitly recommends against using additional aspirin or anticoagulants to prevent VTE in long-distance travelers, as the evidence does not support benefit and bleeding risk outweighs any theoretical advantage 1, 2
You are already on dual antiplatelet/anticoagulant therapy (clopidogrel plus apixaban), which provides substantial protection against both arterial and venous thrombosis 2
Adding more anticoagulation would significantly increase your major bleeding risk (approximately 5 per 1,000 patients per year with aspirin alone) without proven VTE prevention benefit 2
Mechanical Prevention Measures (What You SHOULD Do)
Primary Prevention - For All Travelers
Request an aisle seat to facilitate movement without climbing over other passengers, as window seating increases DVT risk sixfold in high-risk individuals due to restricted mobility 1, 3
Ambulate every 2 hours minimum by walking the cabin aisles, as immobility is the primary risk factor for travel-related VTE 1, 4, 2, 3
Perform calf muscle exercises while seated including ankle pumps and knee extensions to maintain popliteal venous flow 1, 4, 2, 3
Maintain adequate hydration by increasing fluid intake by 0.5-1 liter above your usual daily intake to prevent volume depletion that could exacerbate venous stasis 4, 5
Compression Stockings - Consider If You Have Additional Risk Factors
Wear properly fitted below-knee graduated compression stockings (15-30 mmHg pressure at ankle) if you have additional VTE risk factors including previous VTE, recent surgery or trauma, active malignancy, advanced age, limited mobility, severe obesity, or known thrombophilic disorder 1, 4, 2
Compression stockings reduce symptomatic DVT risk by 90% (relative risk 0.10) in long-distance travelers, with an absolute risk reduction of 540 fewer proximal DVTs per 1,000 travelers 1, 2
Critical fitting caveat: Stockings must be properly fitted - if too tight around the knee they can prevent venous return and paradoxically increase DVT risk by causing blood pooling 1
Put stockings on 2-3 hours before the flight and wear throughout the entire journey 1
Understanding Your Baseline Risk
The absolute risk of symptomatic VTE is approximately 1 per 4,600 flights over 4 hours in the general population 2, 3, 6
This risk increases by 18% for each additional 2 hours of travel time 2, 3
For flights over 12 hours, the rate of severe symptomatic pulmonary embolism is 5 per million passengers 6
Your cardiovascular disease requiring dual antiplatelet/anticoagulant therapy may place you in a higher risk category, making mechanical prevention measures particularly important 1
Important Caveats About Your Medications
Do NOT stop your clopidogrel or Eliquis for travel - the thrombotic risk from discontinuing these medications far exceeds any travel-related VTE risk 1
Be aware that your bleeding risk is already elevated on dual therapy, so avoid trauma during travel (careful with overhead bins, avoid alcohol which increases fall risk) 2
Ensure you have adequate medication supply for your entire trip plus extra days in case of travel delays 1
What NOT to Do
Do not take additional aspirin - it provides no VTE prevention benefit and only increases your bleeding risk 1, 2
Do not take sedatives or sleep medications that would prevent you from ambulating during the flight 2
Avoid prolonged immobility regardless of seat location 3
Do not use alcohol excessively as it promotes dehydration and increases bleeding risk on your current medications 7