This leaflet advises on how to reduce the risk of a deep vein thrombosis occurring during a long journey. Another leaflet discusses deep vein thrombosis in more detail.
What is a deep vein thrombosis?
A deep vein thrombosis (DVT) is a blood clot that forms in a deep vein, usually in the leg. The deep veins in the leg are blood vessels which go through the calf and thigh muscles, and are not those which you can see just below the skin.
What is travel-related deep vein thrombosis?
Long journeys (more than four hours) by plane, train, bus, car, etc, are thought to cause a slightly increased risk of DVT. This is probably due to sitting immobile and cramped for long periods. Blood flows more slowly and collects in the legs when they are hanging down. Blood flowing slowly is more likely to make a clot.
The risk of DVT from travel is small. Research studies suggest that there is about one DVT for every 4,656 flights that last for four hours or more. The longer the flight, the more likely you are to develop a DVT. It has to be stressed that the vast majority of travellers have no problems. Other risk factors are involved, so for most people the chance of developing a DVT just from a long journey is very small.
Is a deep vein thrombosis serious?
It can be. When a blood clot forms in a leg vein, it usually remains stuck to the vein wall. The symptoms tend to settle gradually but there are two main possible complications:
- A blood clot in the lung (pulmonary embolus) occurs in a small number of people who have a DVT. An embolus is a part of a blood clot which breaks off and travels in the bloodstream. An embolus that comes from a clot in a leg vein may be carried up in the bloodstream and can become stuck in one of the blood vessels of the lung. This is serious and can sometimes be fatal.
- Long-term discomfort and swelling of the calf occur in some cases following a DVT (post-thrombotic syndrome).
Who is at risk of having a deep vein thrombosis when they travel?
Anyone may develop a DVT following a long journey but the following increase the risk:
- Having had an operation in the previous two months.
- Having had a DVT or pulmonary embolism (PE) before. (If you have had a DVT or PE before and are still taking anticoagulant medication, you are not at a higher risk.)
- Having a close relative who has had a DVT or PE.
- Being on contraceptive hormone pills, patches or rings and hormone replacement therapy (HRT).
- Being very tall or very short.
- Some blood clotting disorders (for example, polycythaemia or thrombophilia).
- Having a broken leg which is in plaster.
- Recent severe illness such as pneumonia or heart failure or a heart attack.
Remember, even if you have one of these risk factors, the chance of developing a DVT after a journey is still small. However, it makes sense to try to reduce even this small risk if possible.
How can I reduce the risk of travel-related deep vein thrombosis?
Whilst travelling on a long journey, particularly on a long-haul plane trip:
- Exercise your calf and foot muscles regularly:
- Every half hour or so, bend and straighten your legs, feet and toes when you are seated.
- Press the balls of your feet down hard against the floor or foot rest every so often. This helps to increase the blood flow in your legs.
- Take a walk up and down the aisle every hour or so, when the seatbelt signs are not switched on.
- Make sure you have as much space as possible in front of you for your legs to move. So avoid having bags under the seat in front of you and recline your seat where possible.
- Take all opportunities to get up to stretch your legs, when there are stops in your journey.
- Drink normal amounts of fluid to avoid a lack of fluid in the body (dehydration).
- Do not drink too much alcohol. (Alcohol can cause dehydration and immobility.)
- Do not take sleeping tablets, which cause immobility.
Elastic compression stockings
There is some evidence to suggest that compression stockings can help to prevent travel-related DVT in people who have a high to moderate risk. You can buy the stockings (or 'flight socks') from pharmacies. Ask the pharmacist for advice about the correct sort. They need to be 'graduated compression' stockings, worn to the knee, with the correct amount of compression (class 1). The slight pressure from the stocking helps to prevent blood 'pooling' in the calf. Stockings do not replace the need for regular exercises. They are in addition to exercises. If you have any of the risk factors mentioned above, it would be wise to wear these stockings for your journey. (Unless you have a plaster cast on your leg, which would usually be split for the journey. Consult your fracture clinic for advice.)
Some people at particularly high risk of DVT may be advised to have a heparin injection before a long-haul flight. Heparin is an anticoagulant, meaning it 'thins the blood' and makes it less likely to clot. See your doctor before the journey to discuss this option if you:
- Have thrombophilia.
- Have cancer which is being treated.
- Have had major surgery in the previous four weeks. Specifically if you have had an operation under a general anaesthetic lasting more than 30 minutes. If you have had a hip or knee replacement within the previous three months, you should avoid long-haul flights altogether.
Note: aspirin is not used to prevent DVT. (Aspirin is widely used to help prevent blood clots in arteries, which can cause strokes and heart attacks. However, aspirin does not seem to be very effective at preventing clots in veins.)
Further research may clarify the value of compression stockings and heparin, or find other ways of preventing DVT.
After the journey
Have a little walk straight after the journey to 'get the circulation going'. The vast majority of travellers have no problems. However, if you develop a swollen painful calf or breathing difficulties shortly after a long journey then see a doctor urgently. Note: slight painless puffiness of feet and ankles is common after a long journey and is not due to a DVT.
Further reading and references
Prevention and management of venous thromboembolism; Scottish Intercollegiate Guidelines Network - SIGN (December 2010, updated October 2014)
Guidelines on travel-related venous thrombosis; British Journal of Haematology - British Committee for Standards in Haematology (September 2010)
DVT prevention for travellers; NICE CKS, March 2013 (UK access)
Watson HG, Baglin TP; Guidelines on travel-related venous thrombosis. Br J Haematol. 2011 Jan152(1):31-4. doi: 10.1111/j.1365-2141.2010.08408.x. Epub 2010 Nov 18.
Kuipers S, Cannegieter SC, Middeldorp S, et al; The absolute risk of venous thrombosis after air travel: a cohort study of 8,755 employees of international organisations. PLoS Med. 2007 Sep4(9):e290.
Izadi M, Alemzadeh-Ansari MJ, Kazemisaleh D, et al; Do pregnant women have a higher risk for venous thromboembolism following air travel? Adv Biomed Res. 2015 Feb 234:60. doi: 10.4103/2277-9175.151879. eCollection 2015.