Travel Vaccines for Holiday
Reducing the Risk of DVT in Long Distance Traveller
Deep vein thrombosis, or DVT occurs when blood clots develop in the deep veins of the legs (usually only one leg). DVT is serious, as it can occasionally lead to a potentially fatal condition known as pulmonary embolism (PE), due a blood clot travelling from the leg to the lungs, causing an obstruction to blood flow to the lungs. This cannot happen with blood clots in superficial varicose veins in the legs, called phlebitis.
DVT is rare in travellers, but sitting still for as little as four hours in a plane, train or car can increase the risk.
These factors are considered to be risk factors for DVT:
Signs of DVT
You may get swelling, pain, tenderness and redness especially at the back of the leg below the knee. This is different from the mild ankle swelling that many people get during long journeys and DVT usually though not always affects only one leg. These complaints may develop during the journey but more commonly hours or even days and up to 4 weeks later. The pain may be made worse by bending the foot upward towards the knee. In some cases there may be no signs or symptoms of DVT at all in the legs and problems only become obvious when a pulmonary embolus or PE develops from the clots in the legs. Fortunately PE is rare. PE can cause breathlessness, chest pain and in severe cases, collapse and death. Both DVT and PE, whatever the cause, are serious conditions and need urgent investigation and treatment.
How to reduce the Risk
Consult your doctor before you travel if you have:
People who have had hip or knee replacements ideally should postpone long haul travel for three months after surgery. If you have had this kind of surgery, talk to your family doctor, travel specialist, or a member of the surgical team. Some people at very high risk may be prescribed clot preventing medication such as low molecular weight heparin.
Women who are pregnant, or have recently had a baby should seek advice from their antenatal team or health visitor.
Those with moderately increased risk such as travellers aged over 40, overweight travellers, and women taking the 'pill' or on hormone replacement therapy (HRT) should follow the advice given below in the “During the Trip” section to help reduce the risk. They should also discuss the use of graduated compression stockings with their pharmacist. Graduated compression stockings are widely available from pharmacies and pharmacists can provide advice on use and fitting. There is good evidence that graduated compression stockings can be useful in reducing risk.
Travellers without other risk factors should follow the advice given below in the “During the Trip” section, and may consider the use of graduated compression stockings.
There is no evidence that aspirin is effective in preventing travel-related DVT or PE. Because aspirin can have serious side effects like bruising, bleeding from the gut and allergies you should consult your doctor before deciding to take this drug. People taking aspirin already should not increase the dose.
During the trip
After the trip
For the vast majority of travellers there will be no problems upon arrival at your destination. However symptoms of DVT can appear after arrival. If you develop swollen painful legs, especially where one is more affected than the other, or if you have breathing difficulties, see a local doctor urgently or go to the nearest A&E department.