Travel and the risk of symptomatic venous thromboembolism

Marije ten Wolde; Roderik A. Kraaijenhagen; Jan Schiereck; Petronella J. Hagen; Joost J. Mathijssen; Melvin R. Mac Gillavry; Maria M.W Koopman; Harry R. Büller

doi:10.1055/s-0037-1613380

Thrombosis and Haemostasis, Inhaltsverzeichnis

Thromb Haemost 2003; 89(03): 499-505
DOI: 10.1055/s-0037-1613380

Blood Coagulation, Fibrinolysis and Cellular Haemostasis

Schattauer GmbH

Travel and the risk of symptomatic venous thromboembolism

Autoren

Marije ten Wolde

¹Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands
Roderik A. Kraaijenhagen

¹Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands
Jan Schiereck

²Department of Radiology, University Medical Center, Utrecht, The Netherlands
Petronella J. Hagen

³Department of Pulmonary Medicine, Vrije Universiteit Medical Center, Amsterdam, The Netherlands
Joost J. Mathijssen

¹Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands
Melvin R. Mac Gillavry

⁴Department of Internal Medicine, Slotervaart Hospital, Amsterdam, The Netherlands

⁵Clnical Epidemiology and Biostatistics, Academic Medical Center, Amsterdam, The Netherlands
Maria M.W Koopman

¹Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands
Harry R. Büller

¹Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands

Abstract

Summary

Whether long-distance travel and symptomatic venous thromboembolism (VTE) are associated is debated. On the basis of the available literature a fair risk estimate cannot be obtained. We estimated an accurate odds ratio for the relationship between recent travelling and symptomatic VTE.

From three case-control studies consisting of 788 and 170 patients with clinically suspected deep vein thrombosis (DVT) and 989 patients with clinically suspected pulmonary embolism (PE) referred for diagnostic work-up, a pooled odds ratio for the relation between travel and symptomatic VTE was calculated. Cases were patients in whom the diagnosis was confirmed according to a diagnostic management strategy, whereas controls were patients in whom the diagnosis was excluded and who had an uneventful clinical follow-up. Patients were seen in the period April 1997 to September 2000. Travel history was recorded prior to diagnostic work-up.

The pooled odds ratio for the association between any travel and symptomatic venous thromboembolism was 0.9 (95% CI: 0.6-1.4). The median travel time was 7 h (quartile range 4 to 10 h). Separate analyses performed for different types of transport (plane, car, bus or train) yielded comparable odds ratios. The analysis for duration of travelling showed an increased odds ratio of 2.5 (95% CI: 1.0-6.2) in the category of 10-15 h of travelling.

This study shows that the average traveller does not have an increased risk for symptomatic venous thromboembolism. Only very long travelling (more than 10 h) may be associated with venous thromboembolic disease.

Keywords

Deep vein thrombosis - pulmonary embolism - travel

Volltext

Referenzen

References
1 Wells PS, Anderson DR, Bormanis J, Guy F, Mitchell M, Gray L, Clement C, Robinson KS, Lewandowski B. Value of assessment of pretest probability of deep-vein thrombosis in clinical management. Lancet 1997; Dec 20 27 350 9094 1795-8.
2 Oger E, Leroyer C, Le Moigne E, Pomey MP, Bressollette L, Clavier J, Mottier D. The value of a risk factor analysis in clinically suspected deep venous thrombosis. Respiration 1997; 64 (05) 326-30.
3 Heit JA, Silverstein MD, Mohr DN, Petterson TM, O’Fallon WM, Melton LJ. Risk factors for deep vein thrombosis and pulmonary embolism: a population-based case-control study. Arch Intern Med 2000; 160 (06) 809-15.
4 Bauer KA. The thrombophilias: well defined risk factors with uncertain therapeutic implications. Ann Intern Med 2001; 135: 367-73.
5 Vandenbroucke JP, Rosing J, Bloemenkamp KW, Middeldorp S, Helmerhorst FM, Bouma BN, Rosendaal F. R.Oral contraceptives and the risk of venous thrombosis. N Engl J Med 2001; 344 (20) 1527-35.
6 Daly E, Vessey MP, Hawkins MM, Carson JL, Gough P, Marsh S. Risk of venous thromboembolism in users of hormone replacement therapy. Lancet 1996; 348 9033 977-80.
7 Simpson K. Shelter deaths from pulmonary embolism. Lancet 1940; 2: 744
8 Homans J. Thrombosis of the leg veins due to prolonged sitting. N Engl J Med 1954; 250: 148-9.
9 Cruickshank JM, Gorlin R, Jennett B. Air travel and thrombotic episodes: the economy class syndrome. Lancet 1988; 2: 497-8.
10 Bendz B, Rostrup M, Sevre K, Andersen TO, Sandset PM. Association between acute hypo-baric hypoxia and activation of coagulation in human beings. Lancet 2000; 356: 1657-8.
11 Arvidsson B, Eklof B, Kistner RL, Masuda EM, Sato D. Risk factors for venous thromboembolism following prolonged air travel: a prospective study. Vasc Surg 1999; 33: 537-44.
12 Eklof B, Kistner RL, Masuda EM, Sonntag BV, Wong HP. Venous thromboembolism in association with prolonged air travel. Dermatol Surg 1996; 22: 637-41.
13 Mercer A, Brown JD. Venous thromboembolism associated with air travel: A report of 33 patients. Aviat Space Environ Med 1998; 69: 154-7.
14 Milne R. Venous thromboembolism and travel: is there an association?. J R Coll Physicians Lond 1992; 26: 47-49.
15 O’Donnell D. Thromboembolism and air travel. Lancet 1988; 2: 797-7.
16 Symington IS, Stack BH. Pulmonary thromboembolism after travel. Br J Dis Chest 1977; 71: 138-40.
17 Ferrari E, Chevallier T, Chapelier A, Baudouy M. Travel as a risk factor for venous thromboembolic disease – A case-control study. Chest 1999; 115: 440-4.
18 Kraaijenhagen RA, Haverkamp D, Koopman MMW, Prandoni P, Piovella F, Büller HR. Travel and risk of venous thrombosis. Lancet 2000; 356: 1492-93.
19 Samama MM. An epidemiologic study of risk factors for deep vein thrombosis in medical outpatients: the Sirius study. Arch Intern Med 2000; 160: 3415-20.
20 Dimberg LA, Mundt KA, Sulsky I S, Liese BH. Deep venous thrombosis associated with corporate air travel. J Travel Med 2001; 8: 127-32.
21 Arya R, Barnes JA, Hossain U, Patel RK, Cohen AT. Long-haul flights and deep vein thrombosis: a significant risk only when additional factors are also present. Br J Haematol 2002; 116: 653-4.
22 Lensing AW, Prandoni P, Brandjes D. et al Detection of deep-vein thrombosis by real-time B-mode ultrasonography. N Engl J Med 1989; 320: 342-5.
23 Cogo A, Lensing AW, Koopman MM. et al Compression ultrasonography for diagnostic management of patients with clinically suspected deep vein thrombosis: prospective cohort study. Br Med J 1998; 316: 17-20.
24 Bernardi E, Prandoni P, Lensing AW. et al D-dimer testing as an adjunct to ultrasonography in patients with clinically suspected deep vein thrombosis: prospective cohort study. Br Med J 1998; 317: 1037-40.
25 Kraaijenhagen RA, Piovella F, Bernardi E. et al Simplification of the diagnostic management of suspected deep vein thrombosis. Arch Intern Med 2002; 162: 907-11.
26 Wells PS, Ginsberg JS, Anderson DR. et al Use of a clinical model for safe management of patients with suspected pulmonary embolism. Ann Intern Med 1998; 129 (12) 997-1005.
27 Goodman LR, Lipchik RJ, Kuzo RS, Liu Y, McAuliffe TL, O’Brien DJ. Subsequent pulmonary embolism: risk after a negative helical CT pulmonary angiogram – prospective comparison with scintigraphy. Radiology 2000; 215 (02) 535-42.
28 Wells PS, Anderson DR, Rodger M. et al Excluding pulmonary embolism at the bedside without diagnostic imaging: management of patients with suspected pulmonary embolism presenting to the emergency department by using a simple clinical model and d-dimer. Ann Intern Med 2001; 135 (02) 98-107.
29 Mantel N, Haenszel W. Statistical aspects of the analysis of data from retrospective studies of disease. Journal of the National Cancer Institute 1959; 22: 719-48.
30 Scurr JH, Machin SJ, Bailey-King S, Mackie IJ, McDonald S, Coleridge Smith PD. Frequency and prevention of symptomless deep-vein thrombosis in long-haul flights: a randomised trial. Lancet 2001; 357: 1485-9.
31 Lapostolle F, Surget V, Borron SW, Desmaizieres M, Sordelet D, Lapandry C. et al Severe pulmonary embolism associated with air travel. N Engl J Med 2001; 345: 779-83.
32 Hansson PO, Welin L, Tibblin G, Eriksson H. Deep vein thrombosis and pulmonary embolism in the general population. ‘The Study of Men Born in 1913’. Arch Intern Med 1997; 157: 1665-70.