Travel thrombosis I82.8

Occurrence of a phlebothrombosis of the lower extremity with/without pulmonary embolism complications in a temporal connection with a journey of many hours in a predominantly sitting position in persons who had no evidence of acute venous thromboembolism before the start of the journey.

• Risk group 1 (low risk): Every journey of many hours in a predominantly seated position.
• Risk group 2 (medium risk): In addition to travelling for several hours in a seated position, there are also: pregnancy or postpartum phase.
• Alternative: Presence of at least 2 of the following factors:
• Age > 60 years
• Clinically relevant heart disease
• Proven thrombophilia or familial thrombosis
• ovulation inhibitors, postmenopausal hormone replacement therapy
• Adiposity (BMI > 30)
• Desiccation.
• Risk group 3 (high risk):
• History of thrombophilia, even a long time ago
• Manifest malignant or other serious illness
• Joint immobilization of a lower extremity
• Recent surgery with high risk of thrombosis.

There are no reliable figures on the frequency of travel thrombosis. It is estimated that the prevalence on long-haul flights (> 4 hours) is 1:4,500 -6,000 passengers. The risk of post-thrombotic pulmonary embolism is also increased compared to a control collective.

Possible risks are a known thrombophilia, relevant varicosis, previous thromboses, diabetes mellitus, kidney disease, pregnancy or the use of contraceptives.

• Risk group 1: Movement exercises (bouncing feet, isometric exercises, repeated standing up, ample fluid intake (reduction of diuretic stimulants: coffee, alcohol, tea), avoidance of sedatives and hypnotics during the trip (!)
• Risk group 2: In addition to the measures of risk group 1: wearing of lower leg stockings of compression class 1 or adapted to the degree of CVI. In individual cases (e.g. pregnancy or thrombophilia) treatment with low molecular weight heparin s.c.
• Risk group 3: In addition to the measures described above under risk group 1 or 2: Drug prophylaxis (see c. Injections of low-molecular-weight heparin 2 hours before departure (once a day for round trips).

1. Ansell JE (2001) Air travel and venous thromboembolism--is the evidence in? N Engl J Med 345: 828-829
2. Belcaro G et al (2001) Venous thromboembolism from air travel: the LONFIT study. Angiology 52: 369-374
3. Brown S, disciple M (2003) Travel thrombosis. The dermatologist 54: 518-523
4. Lapostolle F et al (2001) Severe pulmonary embolism associated with air travel. N Engl J Med 345: 779-783
5. Mendis S et al (2002) Air travel and venous thromboembolism. Bull World Health Organ 80: 403-406
6. Partsch H et al (2001) Travel thrombosis 2001. consensus paper. Phlebology 30: 101-103