Avoiding Blood Clots During Long-Distance Travel

A few years ago my fam­ily took a trip to China. Even before we arrived, I learned some­thing about an unfa­mil­iar health care cul­ture. What I observed en route was that many of the older pas­sen­gers on that long flight to Bei­jing were get­ting up from their seats and stretch­ing. Not just once, but reg­u­larly and sys­tem­at­i­cally – they were doing slow motion, iso­met­ric cal­is­then­ics on the airplane.

I took notice of their behav­ior first because it seemed a sim­ple and inex­pen­sive, albeit strange exam­ple of pre­ven­tive med­i­cine. Sec­ond, as a hema­tol­o­gist who cared for patients with blood clots upon trav­el­ing, I pon­dered the risks and ben­e­fits of their on-board exer­cises. Third, as a patient who’s had a blood clot, or deep venous throm­bo­sis (DVT), I thought maybe I should fol­low their example.

Throm­bophlebitis — the old term for DVT – hap­pens when a vein (as opposed to an artery) gets clogged with platelets and fibrous pro­teins. These tend to develop in peo­ple who are immo­bi­lized – after a hip or spine surgery, for exam­ple, or dur­ing long, cramped trips in air­planes with lit­tle legroom. For this rea­son, long-distance travel (in any sort of vehi­cle – it could be a car or bus or a train) is a major risk factor.

Dehy­dra­tion and some med­ica­tions can exac­er­bate the risk of devel­op­ing blood clots dur­ing travel, as can hav­ing some kinds of can­cer. (Pan­cre­atic can­cer, prostate, ovar­ian can­cer and other tumors in the pelvis are par­tic­u­larly trou­ble­some in this regard.) Some peo­ple inherit an increased ten­dency to develop clots; in gen­eral these can be eval­u­ated by blood tests.

Most often DVTs arise in the legs but some­times these also occur in the arms and other body parts. The con­di­tion can cause dis­com­fort, pain, red­ness and swelling of an affected limb. These clots are most dan­ger­ous, and poten­tially lethal, if they spread to the lung — what’s called a pul­monary embolism. So there’s good rea­son to avoid these as best you can.

Here’s a list of some pre­cau­tions to avoid blood clots when traveling:

1. Try to get an aisle seat. This strat­egy allows you to peri­od­i­cally stretch your legs into the aisle, and to get up with­out dis­turb­ing others.

2. While seated, move your feet and legs around as much as cir­cum­stances per­mit, and at least every hour or so. If you absolutely must remain seated, flex your feet 10 times, and stretch your legs as best you can, bend­ing and extend­ing the knees, one at a time, in any avail­able direc­tion, 10 times each. Another exer­cise is to raise each foot and swivel it, piv­ot­ing the toes from side to side while keep­ing the ankle rel­a­tively still.

3. Get up peri­od­i­cally and walk, every hour or two if per­mit­ted. (This means get­ting less sleep if you’re lucky enough to fall asleep, but I think the trade-off is worth it: being tired upon arrival is unpleas­ant; get­ting a blood clot is worse than that.)

If you’re on an air­plane — once you’re up and out of your seat, seek out a place near the kitchen, restroom or else­where where you might stand. Then, hold onto the wall or the back of a chair, lift and stretch each of your legs repeat­edly and then march in place: one knee up, then the next for two min­utes or so, as con­di­tions (and flight atten­dants) allow.

4. Stay well-hydrated by drink­ing ample water. Alco­hol is a diuretic and should be avoided or min­i­mized; caf­feine too. Of course, for some trav­el­ers with weak blad­ders drink­ing lots of flu­ids can cre­ate a need for fre­quent bath­room trips. But this isn’t such a bad thing if you’re at risk for DVT, because this gets you up and out of your seat.

5. Dress sen­si­bly — avoid tight cloth­ing. (Some doc­tors rec­om­mend TED (thrombo-embolic Deter­rent) or other com­pres­sion stock­ings for patients with DVTs who travel, but I find these grad­u­ated com­pres­sion nylons so uncom­fort­able that they reduce mobil­ity, besides the capac­ity to bend and flex my ankles and knees.)

For women: avoid “knee-high” stock­ings with com­pres­sion bands press­ing just below the knees. These are a set-up for reduced blood flow from the lower legs to the larger, cen­tral veins.

6. Talk to your doc­tor if you’re con­cerned about DVT and are plan­ning a trip. Ask about what pre­cau­tions you might take in the con­text of your spe­cific med­ical cir­cum­stances. Some peo­ple use heparin, a blood-thinner, or other med­ica­tions while trav­el­ing to reduce their risk. Keep in mind that for most peo­ple, the risk of form­ing a sig­nif­i­cant blood clot is low.

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The trip to China was fab­u­lous, well worth the distance.

More on travel next week –

ES