Do haematologists use thromboprophylaxis for travel-related VTE?

There may be a lack of consensus in guidelines regarding thromboprophylaxis for prevention of air travel-related venous thromboembolism (VTE), but most haematologists seem to have made a personal decision to use it.

A survey of 403 clinicians who flew to the International Society on Thrombosis and Haemostasis (ISTH) 2019 annual scientific meeting in Melbourne found that 69% of used some form of thromboprophylaxis.

The survey, which drew responses from 11% of conference attendees who took long-haul flights found that half used non-drug prophylaxis and almost one in four (23%) used pharmacological prophylaxis.

Participants in the study had an average age of 47 and had a median flight duration of 22 hours. Most of the survey respondents were medical practitioners and almost 70% flew business class.

The majority (76%) had no risk factors for VTE, 20% had one risk factor and 4% had two risk factors such as history of VTE, first degree relative with VTE, recent surgery, lower limb injury/immobility and oestrogen use.

The study investigators, led by Dr Hannah Stevens of the Department of Haematology, Alfred health, Melbourne, noted that a previous review done in 2007 had found about 25% of long haul travellers used some for of thromboprophylaxis – but this was before the era of DOACs.Almost one in ten said they regularly used pharmacological thromboprophylaxis prior to flight. Among those who used drug prophylaxis, the most common were antiplatelets (41%), LMWH (20%) and DOACs such as rivaroxaban (22%).

They said they would do further follow up to asses the impact of thromboprophylaxis on clinical events.

In the initial survey. one central venous sinus thrombosis was reported in an attendee who did not use preventative measures, and one minor bleed (epistaxis) occurred in a person taking aspirin.

The findings were presented at the ISTH 2020 virtual meeting.

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