Over 94 million Americans are expected to travel this holiday season. One thing there will be lots of: sitting. The risk for developing venous thromboembolism, VTE--blood clots known as deep vein thrombosis (DVT) and pulmonary embolism (PE)--increase with any form of lengthy immobility, including when seated for a prolonged period of time when traveling by car, bus, train or plane.
While the overall incidence of travel-related VTE is thought to be low, long-distance travel may increase blood clot risk by 2 to 4 times compared to short trips. In general, clotting risk increases with the length of travel time and with the addition of pre-existing risk factors (listed below).
Tips for reducing VTE risk while traveling
People can reduce their risk for developing a blood clot by taking simple precautions. Stay as active as possible. If traveling by car, take frequent travel breaks to stop and stretch your legs. If traveling by plane, train or bus:
- Get up periodically to walk the aisle.
- Choose an aisle seat when feasible so it is easier for you to get up and move around during your trip.
- Store luggage in the overhead bin to provide more leg room to stretch.
- Do calf-muscle exercises at your seat. Raise your heels, keeping your toes on the floor, then bring them down. Do this several times. Now raise and lower your toes several times. Repeat this every half an hour (more often if you like).
- Wear comfortable clothing that doesn’t overly constrict the legs or waist.
- Avoid sitting with legs crossed.
If you are at high-risk for developing VTE:
In addition to the above prevention measures, persons with pre-existing risk factors for developing blood clots may need extra prevention measures when traveling. Risk is increased further for persons with:
- a previous DVT or PE
- age over 40 years
- recent major surgery or major trauma (within last 3 months)
- active cancer
- pregnant or have recently given birth (within 3 months)
- a leg cast or immobilizer
- use estrogen containing birth control pills, patches, rings
- use hormone replacement therapy
- varicose veins in the legs
- obesity (body mass index of 30 kg/m2 and above).
- a clotting disorder (thrombophilia)
If you think you have a higher risk for developing VTE while traveling, talk to your doctor about appropriate prevention measures. These may include:
- Use of properly fitted graduated compression stockings. (15-30 mm Hg pressure at the ankle)
- Use of an anticoagulant (blood thinner) medication if at particularly high-risk.
Know the symptoms of DVT and PE
While the immobility of long travel may contribute to the formation of a blood clot, the symptoms of DVT or PE may not appear right away. One should always be aware of the symptoms of DVT and PE, but be especially mindful in the weeks following a long trip.
Deep Vein Thrombosis (DVT):
Symptoms range from mild to severe; may involve the foot, ankle, calf, whole leg or arm. The classic symptoms are:
- Discoloration (bluish or reddish)
A potentially life-threatening complication of deep vein thrombosis (DVT) is pulmonary embolism, often referred to as PE for short. A PE occurs when a blood clot breaks off, travels through the blood stream and lodges in the lung.
Pulmonary Embolism (PE):
A blood clot in the lungs. The classic symptoms are:
- Shortness of breath
- Chest pain (may be worse with deep breath)
- Unexplained cough (may cough up blood)
- Unexplained rapid heart rate
Recently diagnosed with DVT or PE and wondering if it is ok to travel?
Some experts recommend against airline travel during the first 4 weeks following deep vein thrombosis (DVT) or pulmonary embolism (PE). However, there is little scientific evidence to support this guidance. Some data have indicated that the hypobaric (low pressure) condition in the airline cabin activates our clotting mechanism and that that is one of the reasons why people who fly long-distance have an increased risk for developing DVT and PE. However, whether that is truly of clinical relevance is not known. Since it is not fully known whether airline travel in the first few weeks after an acute DVT or PE is truly detrimental and should really be avoided, the recommendation to avoid air travel is more a cautious suggestion than a firm avoidance.
Are there official guidelines about the prevention of travel associated VTE?
Yes. The American College of Chest Physician (ACCP) 2012 guidelines have the following recommendations regarding long-distance travel:
- For long-distance travelers at increased risk of VTE (venous thromboembolism), frequent ambulation, calf muscle exercise, or sitting in an aisle seat if feasable is suggested, as well as wearing of properly fitted, below-knee graduated compression stockings (15-30 mm Hg pressure at the ankle). This includes individuals with:
- previous clots
- recent surgery or trauma
- active cancer
- estrogen use (with birth control methods or other hormonal therapy)
- advanced age
- limited mobility
- severe obesity
- or a known clotting disorder (thrombophilia)
- ACCP 2012 suggests against the use of aspirin or blood thinners to prevent clots.
Additional resources about travel associated VTE
From the CDC, information on preventing DVT/PE associated with travel:
For patients: http://wwwnc.cdc.gov/travel/page/dvt
Warfarin (Coumadin®, Jantoven®) has been the mainstay of oral anticoagulant ("blood thinning") therapy for more than 50 years. Though an effective therapy, warfarin’s challenges are well-known, such as the need for frequent monitoring and dosage adjustments and its sensitivity to diet and lifestyle factors.
Three new oral anticoagulants have been FDA approved over the past three years: apixaban (Eliquis®), dabigatran (Pradaxa®), and rivaroxaban (Xarelto®). Each of these new oral anticoagulants have both advantages and disadvantages compared to warfarin.
To assist patients understanding of the anticoagulant options now available, Clot Connect has created a two-page handout “Comparison of oral blood thinners”. The handout is available as a .pdf at this link.
Increasing knowledge of blood clots, clotting disorders and anticoagulation
As you plan your year-end charitable contributions, please consider supporting Clot Connect's mission to increase knowledge of deep vein thrombosis (DVT) and pulmonary embolism (PE). Tax-deductible donations can be made online by credit card or by mail with a check.
To donate online by credit card, visit this link and select 'DVT Fund'.
To donate by check:
Make checks payable to: The Medical Foundation of NC-DVT Fund 91388
And mail to: The Medical Foundation of North Carolina, Inc. 880 MLK Jr. Blvd. Chapel Hill, NC 27514
About Clot Connect
Clot Connect®(clotconnect.org) is an information and outreach project at the University of North Carolina at Chapel Hill in the Hemophilia and Thrombosis Center. Its mission is to increase knowledge of thrombosis, thrombophilia and anticoagulation by providing education and support resources for patients and health care professionals. Please find additional information about Clot Connect--including our outreach, budget, and plans for the future-- in our 2013 Program Report.
A message from Dr. Stephan Moll, Clot Connect Medical Director
We created the Clot Connect program in 2010 because of an unmet need for information on blood clots and clotting disorders. We could scarcely have imagined the demand we would soon encounter for our resources. Since then, nearly 400,000 people in over 190 countries have been connected to information on the diagnosis, treatment and prevention of deep vein thrombosis and pulmonary embolism.
Our audience has grown rapidly and today we reach over 30,000 people per month with our educational information. We have received very positive feedback about the program and its information from patients and health care professionals.
With the success comes a challenge. It takes funds to conduct an outreach program. It takes funds to maintain the program in its present form, and even more to expand its services. Clot Connect currently receives no federal, state or university financial assistance.
For us to continue to provide free public educational outreach, we must rely upon the generous support of private individuals like you. If you have found Clot Connect’s resources useful and would like to see its availability continue and grow, I ask you to please consider making a donation to support the program.
Thank you very much for your support of Clot Connect and our mission to increase knowledge of blood clots, clotting disorders, and treatment with blood thinners.
Stephan Moll, MD
Associate Professor, University of North Carolina School of Medicine
Department of Medicine, Division of Hematology-Oncology
Clot Connect and blood clot awareness are currently featured on CNN's 'Impact your world', a segment featuring people and organizations around the world making a difference in the lives of others.
In 2010, NASCAR driver Brian Vickers nearly lost his life to blood clots, known as deep vein thrombosis (DVT) and pulmonary embolism (PE). In the CNN 'Impact your world' segment, he talks about his clotting experience and how he is working with Clot Connect to increase awareness. The segment began airing October 8, 2013 and can be viewed online, at this link.
Clot Connect "was an organization I didn't even know of prior to having clots. You know, I didn't even think about blood clots at all. I'd never even thought about it, and who gets blood clots and why? I just never thought it would be something I would have to deal with." Vickers hopes to help change that and help Clot Connect not only raise money for treatment and prevention but also to educate more people about how warning signs present themselves." -CNN Impact Your World
About DVT and PE
Upwards of 600,000 Americans each year are affected by deep vein thrombosis (DVT) and pulmonary embolism (PE). Approximately 1/3 of cases result in death. Many blood clots and their complications are preventable. Education--of both patients and healthcare professionals--is essential to improving health outcomes.
Resources for patients and healthcare professionals on DVT, PE and anticoagulation can be found online at www.ClotConnect.org
About Clot Connect
Clot Connect is an information and outreach project at the University of North Carolina at Chapel Hill Hemophilia and Thrombosis Center, online at www.ClotConnect.org. Clot Connect provides patients and healthcare professionals connection to clinically relevant education resources on deep vein thrombosis, pulmonary embolism, thrombophilia and anticoagulation. Since 2010, over 423,000 people from over 190 countries have been connected to information on the diagnosis, treatment and prevention of deep vein thrombosis and pulmonary embolism through ClotConnect.org. More information on the program (including outreach activities, audience and budget) is available in the 2013 Program Report.
A new VTE awareness video is now on YouTube. The Clot Busters video is intended to raise provider awareness around venous thromboembolism (VTE) prevention in hospitalized patients.
The video was produced and directed by the University of North Carolina at Chapel Hill Medical Center’s Nursing Quality Council. For more information about VTE prevention activities at UNC Hospitals, contact Carolyn M. Namde RN, MSN, CNL, Clinical Quality Assurance Specialist- VTE, University Of North Carolina Health Care, Performance Improvement & Patient Safety
About hospital associated VTE:
- 40% of all VTE are associated with hospitalization, occurring either in the hospital or shortly after discharge
- VTE is one of the leading preventable causes of hospital death
- Clot Connect has pulled together resources which may be helpful for hospitals and organizations developing a VTE prevention strategy. They can be found, at this link.
Clot Connect (clotconnect.org) is an outreach initiative housed within the Hemophilia and Thrombosis Center of the University of North Carolina at Chapel Hill which since late 2010 has provided information on the diagnosis, treatment and prevention of deep vein thrombosis and pulmonary embolism. Clot Connect has evolved rapidly during the past 3 years and this growth is highlighted in a special report which details the history and outreach activities of the program. The report is available, at this link.
Highlights of the program report include:
- Since 2010, over 423,000 people from over 190 countries have been connected to information on the diagnosis, treatment and prevention of deep vein thrombosis and pulmonary embolism through ClotConnect.org. (page 7)
- The clotconnect.org website receives between 20,000-30,000 unique individual visitors each month. (page 7)
- The 'networked community' continues to grow. 1,000+ persons receive the program’s email newsletter each month, ~1200 persons have opted to receive blog updates by email, ~1000 linked via social media. (page 7)
- The program has increasingly engaged in national clot education initiatives (page 5)
- Clot Connect is entirely supported through grants and donations. The program is currently in need of sustainable funding to continue the provision of services. (page 8)
Improving health outcomes requires a multifaceted approach and education--of both patient and health care professional--is a key component in supporting a comprehensive care model. Clot Connect presents a unique opportunity to address an unmet need.
For patients, it means empowering them with knowledge about their condition and treatment so they can be active partners in their health care, resulting in better and safer treatment, greater satisfaction and an improved quality of life.
For health care professionals, it means providing them with the information and resources they need to confidently and consistently provide quality care to patients who have experienced venous thromboembolism.
Clot Connect is pleased with the successes of the past two and half years, but realize there is far more to do. We look forward to continuing to meet the educational needs of patients and health care professionals.
Clot Connect's Mission
To increase knowledge of venous thrombosis, thrombophilia and anticoagulation by connecting patients and health care professionals to educational and support resources.
Clot Connect's Vision
To become the premier resource for information on venous thrombosis, thrombophilia and anticoagulation by addressing what patients and health care professionals have on their minds and want to know about thrombosis, thrombophilia and anticoagulation.
We want to hear how Clot Connect helps you! Please take a moment to provide us with feedback on Clot Connect in a brief survey...less than five questions!
President Barack Obama has proclaimed May 12 through May 18, 2013, as National Women's Health Week. "I encourage all Americans to celebrate the progress we have made in protecting women's health and to promote awareness, prevention, and educational activities that improve the health of all women." Read the full proclamation, here.
National Women's Health Week is a week-long health observance coordinated by the U.S. Department of Health and Human Services' Office of Women's Health. It brings together communities, businesses, government, health organizations, and other groups in an effort to promote women's health and its importance.
While blood clots (deep vein thrombosis and pulmonary embolism) affect both men and women, there are unique health considerations for women.
- Blood clots can be life-threatening during pregnancy and are the leading cause of maternal death in the United States. (ref 1)
- A woman is at increased risk for developing blood clots during pregnancy and that risk remains elevated for up to six-weeks following childbirth. Pregnancy increases the risk of a blood clot fivefold, with the risk even higher in the postpartum timeperiod. (2)
- Post-menopausal women undergoing hormone replacement therapy have a two to four fold increase in the risk for clots. (3)
- Women with a clotting disorder (thrombophilia) have increased clot risk. About 8% of the US population is estimated to have a clotting disorder and a clotting disorder is found in upwards of 50% of women who have a blood clot during pregnancy.
- Women with a clotting disorder experience a higher rate of pregnancy complications including repeated miscarriage or stillbirth.(4)
- Oral contraceptives increase clot risk. Some contraceptives carry higher risk than others. More information on contraceptives and clot risk. (5)
Clot Connect offers information about clotting concerns unique to women: index of topics and materials related to women's health.
1. Berg CJ, Atrash HK, Koonin LM, Tucker M. “Pregnancy-related mortality in the United States 1987-1990”. Obstet Gynecol 1996;88(2):161-7 Also see Marik. P.E. and Plante, L.A. “Venous Thromboembolic Disease and Pregnancy”. New England Journal of Medicine, volume 359, number 19, November 6, 2008, pages 2025-2033.
2.Heit JA, Kobbervig CE, James AH, Petterson TM,Bailey KR, Melton LJ, 3rd. Trends in the incidenceof venous thromboembolism during pregnancy or postpartum: a 30-year population-based study. Ann Intern Med 2005;143(10):697-706
3. Surgeon General’s Call to Action to Prevent Deep Vein Thrombosis and Pulmonary Embolism US Department of Health and Human Services 2008
4. March of Dimes
Clot Connect is featured as an educational resource in a national public television program called ‘Healthy Bodies, Healthy Minds’.
Clot Connect’s Medical Director Dr. Stephan Moll and Program Director Beth Waldron appear in the newly released episode entitled “Preventing Deep Vein Thrombosis and Pulmonary Embolism: Dangerous Blood Clots”. The episode examines what can be done to prevent DVT and PE. It also explores how physicians and public health experts are finding ways to help people lower their risk for blood clots.
The program features the personal story of a local patient, Roger Callanan, who experienced DVT and PE. The episode also includes Leslie Mason, a Quality & Organizational Excellence Leader in UNC's Performance Improvement and Patient Safety office, who is working to reduce hospital acquired blood clots.
The entire episode can be watched online at the production company's website, at this link.
A PBS local listings schedule of when the episode airs can be found, here.