Question 3; she will travel to South Korea. What would you suggest for her?
This patient is considered to have a moderate to high risk of VTE related to long haul flight due to
1.Previous history of VTE ( DVT)
2.Old Age (age above 40 y/o
3.The duration of direct flight from Bangkok to Seoul is estimated to be 5-6 hours. ( >4 hours)
Therefore, the preventive measures are strongly recommended as followed.
1.Sitting at aisle seat ; more space for frequent ambulation.
2.Performing Calf muscle exercise every 1-2 hours during the flight.
3.Avoiding drinking beverages with diuretic effect i.e. alcohol, soft drink, coffee.
4.Wearing below-knee stocking with pressure of 15-30 mmHg
5.Primary prophylaxis with anticoagulant may be recommended based on shared decision-making between the treating physician and the patient. Although LMWH is the conventional treatment to prevent travel-related VTE, current data suggests that DOACs may be used instead of LMWH because of the convenience. However, due to its limited data and concern of bleeding complication, decisions to prescribe an anticoagulant must always be considered based on a balance between risk of thrombosis and bleeding in individual basis.
1.CDC Yellow book,Chapter : Deep vein thrombosis & Pulmonary embolism.
2.Chamnanchanunt S, Rojnuckarin P. Direct Oral Anticoagulants and Travel-related Venous Thromboembolism. Open Med (Wars). 2018 Nov 27;13:575-582.