From the Research
To prevent pulmonary embolus during air travel, low molecular weight heparin (LMWH) is recommended for high-risk individuals, with a prophylactic dose of enoxaparin 40mg subcutaneously once daily being appropriate for most high-risk patients. This dose should be administered 2-12 hours before the flight and continued daily for trips lasting multiple days 1. Alternatively, dalteparin 5000 units subcutaneously once daily can be used. For very high-risk patients with a history of venous thromboembolism, therapeutic dosing may be considered: enoxaparin 1mg/kg twice daily or dalteparin 100 units/kg twice daily. The medication should be self-injected into the abdomen or thigh using pre-filled syringes.
Some key points to consider when using LMWH for pulmonary embolus prevention during air travel include:
- The risk of deep vein thrombosis and pulmonary embolism increases with the duration of the flight, with flights longer than 4 hours posing a higher risk 2
- Individual risk factors for air travel-related venous thromboembolism include age over 40 years, gender (female), women who use oral contraceptives, varicose veins in lower limbs, obesity, and genetic thrombophilia 2
- Non-pharmacological measures are also important, including staying hydrated, avoiding alcohol and sedatives, performing calf exercises hourly, walking around the cabin when possible, and wearing compression stockings (20-30 mmHg at the ankle) 3
- Prophylaxis is particularly important for flights longer than 4 hours and for those with additional risk factors such as previous clots, recent surgery, active cancer, pregnancy, or known thrombophilia 4, 5, 3, 1
It's essential to note that while LMWH is effective in preventing pulmonary embolus, it's crucial to weigh the benefits against the potential risks, such as bleeding, and to consider individual patient factors when making treatment decisions 4, 5, 3, 1.