Air Travel and Venous Thrombosis: How Much Help Might Aspirin Be?

Yoon K Loke, MBBS; Sheena Derry, MA

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In This Article

Abstract and Introduction

There has been considerable attention focused recently on the risk of deep venous thrombosis (DVT) associated with air travel. Despite the lack of evidence among air travelers, a single dose of aspirin has been widely recommended as a means of preventing such thrombosis. We have calculated the potential benefit of aspirin by applying the data for aspirin in preventing DVT in hip fracture patients to the estimated rates of travel-related DVT. If the rate of travel-related DVT is 20 per 100,000 travelers, then we will have to treat 17,000 people with aspirin to prevent 1 additional DVT.

Following a spate of media reports highlighting the risk of DVT in air travelers, a number of patients have come to your clinic to seek advice on the potential benefits of taking aspirin prior to their journey.

Case Scenario 1: A fit and healthy 23-year-old male medical student is flying out to a distant country for his elective medical attachment. He wonders if he should take a tablet of aspirin prior to his intercontinental flight.

Case Scenarios 2 and 3: A husband and wife are planning a round-the-world trip to celebrate their 25th wedding anniversary. The husband is a normotensive 60-year-old smoker (case 2) and the wife is a healthy 52-year-old nonsmoker (case 3). They have seen newspaper reports that aspirin can help prevent travel thrombosis and would like guidance from a medical practitioner on the value of aspirin.

In the above situations, what evidence-based advice should a physician give?

Much has been written in recent months about the potential risk of DVT with air travel and the measures that could be taken to reduce this risk. In addressing this, a British Government Report recommended that travelers at moderate risk should seek the advice of their doctors on the use of preflight low-dose aspirin.[1] Unfortunately, this advice has been difficult to provide, first because there are insufficient data available for physicians to be able to predict accurately the absolute risk of DVT in specific individuals, and second because there is a complete absence of evidence on the efficacy of aspirin in long-distance travel.

For the patient, postponing this treatment decision until better data become available (in some years), is not an option. In real-life clinical practice, a decision will need to be made there and then, even if the best we can manage is an "educated guess." We have made a projection from existing data of what benefit aspirin might confer, and hope this will help to guide doctors and patients in making therapeutic decisions until more definitive evidence becomes available.

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