From the Guidelines
Flying after a recent diagnosis of acute deep vein thrombosis (DVT) in the left subclavian vein while on Eliquis (apixaban) for two weeks is generally considered safe, but consultation with the treating physician is strongly recommended before travel. Eliquis is an effective anticoagulant that helps prevent clot extension and new clot formation, and two weeks of therapy typically provides adequate initial protection 1. However, individual risk factors must be considered, including the size of the clot, presence of symptoms, and overall clinical stability.
Key Considerations
- The patient should continue taking Eliquis exactly as prescribed (typically 5mg twice daily) without missing any doses during the trip.
- They should also stay well-hydrated, perform frequent leg exercises, walk around the cabin every 1-2 hours when safe to do so, and wear compression stockings if recommended by their doctor.
- The risk of clot extension or pulmonary embolism is significantly reduced once therapeutic anticoagulation is established, which typically occurs within days of starting Eliquis 1.
- Air travel involves prolonged immobility and lower cabin pressure, which theoretically could increase thrombotic risk, making physician clearance important before flying.
Guidance on Travel
According to the american society of hematology 2018 guidelines, for long-distance travelers without risk factors for VTE, the ASH guideline panel suggests not using graduated compression stockings, LMWH, or aspirin for VTE prophylaxis 1. However, this patient has a known risk factor (recent DVT diagnosis), so these recommendations may not apply.
Anticoagulation Therapy
The Chest guideline and expert panel report suggests that for VTE and no cancer, apixaban (Grade 2B) is a recommended long-term anticoagulant therapy 1. This supports the use of Eliquis in this patient.
Final Recommendation
The patient should consult with their treating physician before flying to assess their individual risk factors and ensure it is safe to travel. With proper precautions and continued anticoagulation therapy, the risk of complications during air travel can be minimized.
From the Research
Safety of Flying with Acute DVT
- The safety of flying for a patient diagnosed with an acute DVT in their left subclavian vein and has been on Eliquis for 2 weeks is not directly addressed in the provided studies 2, 3, 4, 5, 6.
- However, the studies discuss the treatment and management of DVT and pulmonary embolism, including the use of anticoagulants such as Eliquis (apixaban) 3, 4, 5, 6.
- According to the studies, apixaban is an effective and safe alternative to traditional anticoagulation therapy for the treatment of DVT and pulmonary embolism 3, 4, 5.
- The studies also discuss the importance of individualized treatment and risk assessment for patients with DVT and pulmonary embolism 2, 6.
Considerations for Flying with DVT
- Patients with DVT are at risk of developing pulmonary embolism, which can be life-threatening 2, 6.
- Flying may increase the risk of pulmonary embolism due to prolonged immobilization and changes in air pressure 6.
- However, the studies do not provide specific guidance on the safety of flying for patients with DVT who are being treated with apixaban 3, 4, 5.
- It is likely that the decision to fly should be made on a case-by-case basis, taking into account the individual patient's risk factors and medical history 2, 6.