Traveling by air offers incredible convenience, connecting us across vast distances for work, leisure, and even medical care. For individuals seeking specialized orthopedic treatment at renowned institutions like Hospital for Special Surgery, international flights are often a necessary part of the journey. However, for those planning long-haul flights, especially exceeding six to eight hours, concerns about blood clots, specifically deep vein thrombosis (DVT) and pulmonary embolism, can arise.
While the risk of developing a blood clot during air travel is generally low, understanding the potential factors and taking simple preventative measures is crucial for a safe and healthy journey. This article will explore the relationship between flying and blood clots, offering practical advice to minimize your risk and ensure peace of mind before, during, and after your flight.
Understanding Deep Vein Thrombosis (DVT)
Deep vein thrombosis (DVT) is a medical condition characterized by the formation of a blood clot in a deep vein, most commonly in the legs or thighs. These clots arise from a combination of slowed blood flow, changes in blood coagulation, and potential damage to the vein walls. Symptoms of DVT can include pain and swelling in the affected leg.
Understanding Pulmonary Embolism (PE)
A pulmonary embolism (PE) occurs when an artery in the lungs becomes blocked. In many cases, this blockage is caused by a blood clot that has traveled from another part of the body, often originating as a DVT in the leg. A PE is a serious condition because it can restrict blood flow to the lungs and lead to significant health complications.
Dr. Anne Bass, an Attending Physician in Rheumatology at HSS, clarifies the potential dangers: “Untreated DVTs can damage the affected vein, leading to chronic swelling and even skin ulcers. Pulmonary emboli can manifest with symptoms like shortness of breath, chest pain, rapid heartbeat, or fainting. In rare, severe instances, a PE can cause a life-threatening blockage of the pulmonary arteries.”
The Connection Between Flying and Blood Clots
While it’s uncommon to develop DVT solely due to flying, long flights do present certain risk factors. Airline passengers often remain seated and relatively immobile for extended periods, often with their legs bent. Additionally, the cabin air environment can contribute to dehydration. Each of these factors can play a role in increasing the likelihood of blood clot formation.
- Immobility: During air travel, passengers typically experience prolonged periods of immobility. Normally, muscle contractions in the legs, facilitated by movement, are essential for circulating blood back to the heart. When the body is still, blood can pool in the legs, increasing the risk of clotting. Furthermore, prolonged sitting often involves bent knees, which can create a kink in leg veins, further hindering circulation.
- Dehydration: The recirculated air in airplanes is often dry, which can lead to dehydration in passengers. Dehydration thickens the blood, making it more concentrated and consequently, more prone to clotting if fluid intake is insufficient.
Practical Steps to Prevent Blood Clots on Flights
Fortunately, there are several effective strategies to minimize the risk of blood clots during long flights. Simple measures can significantly improve circulation and hydration, reducing your chances of DVT.
- Stay Active: Make it a point to stand up, stretch, and walk around the cabin aisle as frequently as possible. Regular movement helps to stimulate blood flow and alleviate vein constriction caused by prolonged sitting.
- Hydrate Well: Combat dehydration by consistently drinking water and other non-alcoholic beverages throughout your flight. Staying hydrated helps maintain healthy blood viscosity and reduces clotting risk.
- Wear Compression Socks: Consider wearing graduated compression stockings. These socks help to improve blood circulation in the legs and prevent blood from pooling. They are readily available at pharmacies and medical supply stores.
Anticoagulants and Air Travel: Considerations Before Surgery
While blood thinners (anticoagulants) might seem like a straightforward solution to prevent blood clots, their use requires careful consideration, especially before surgery. Anticoagulants can increase the risk of bleeding during surgical procedures. Therefore, they are generally prescribed only for patients identified as having a high risk of blood clots based on their medical history or genetic predisposition.
For individuals traveling internationally for surgery at HSS who have a personal or family history of clotting risks, DVT, or pulmonary embolism, it’s essential to discuss treatment options with both their local physician and their HSS doctor prior to travel.
Dr. Bass emphasizes that a history of clotting issues doesn’t necessarily prevent air travel. “Even individuals with an elevated risk of clotting complications can travel to HSS safely, provided they take appropriate preventive measures.”
Flying Before Surgery and Clotting Risks
A long flight taken shortly before surgery can potentially elevate the risk of clotting complications, particularly for patients undergoing orthopedic procedures like hip or knee replacements. Orthopedic surgery, especially procedures involving bone cutting, triggers the body’s clotting system as part of the natural healing process, mirroring the body’s response to injury. Hip and knee replacements carry a higher clotting risk due to the size of the bones involved. Dr. Bass notes that the risk is further amplified in patients with hip fractures due to pre-operative immobilization.
Post-Surgery Blood Clot Risks and Air Travel
All surgical patients face a general risk of blood clotting for approximately four to six weeks post-surgery. Long-distance air travel can exacerbate this risk. As a result, patients traveling long distances after surgery may require enhanced preventive measures.
For instance, blood thinners are commonly prescribed following hip and knee surgeries. If a patient has upcoming air travel plans, their physician will select an appropriate type of blood thinner to accommodate those plans, balancing the risk of clotting with the potential for post-operative bleeding.
Treatment Options for DVT
When DVT is diagnosed, treatment typically involves blood thinners. Heparin injections, administered twice daily, are often used for rapid clot dissolution and to prevent new clot formation. Simultaneously, oral anticoagulants like warfarin (Coumadin®) may be prescribed for longer-term management, typically for three months for leg clots and six months for lung clots.
While effective treatments for DVT exist, especially with early detection, prevention remains the most prudent approach. By understanding the risks associated with air travel and blood clots and implementing preventative strategies, you can significantly reduce your risk and travel with greater confidence.
Updated: 10/12/2022
Summary by Mike Elvin
Authors
Anne R. Bass, MD
Attending Physician, Hospital for Special Surgery
Professor of Clinical Medicine, Weill Cornell Medical College
