II. Indications: Prevention

  1. Hypercoagulable State
  2. Age over 50 years
  3. Prior Venous Thromboembolism
  4. Recent surgery
  5. Recent Trauma
  6. Estrogen or Oral Contraceptive use
  7. Active cancer
  8. Pregnancy
  9. Morbid Obesity
  10. Large Varicose Veins

III. Management: Travel recommendations for flights over 4 hours

  1. Walk 15 minutes each hour of flight
  2. Avoid window seats (85% of DVTs occur in non-aisle seats)
  3. Wear graduated Compression stockings during flight
    1. Below the knee Compression stockings (20-30 mmHg)
    2. Require prescription and measurements for proper fitting (may be covered by insurance)
  4. Maintain adequate hydration
  5. Enoxaparin
    1. Dose prior to flight
  6. Aspirin 80 to 325 mg orally daily is controversial
    1. Not routinely recommended as unlikely to be effective
  7. Rivaroxaban 10 mg before prolonged flight
    1. May be considered in patients at high risk of Venous Thromboembolism
    2. Has not been studied

IV. Course

  1. Venous Thromboembolism may be attributable to travel if event occurs within 8 weeks of travel (onset within 2-3 weeks is typical)

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