BOF:
25
A 27
year old female is due to go on an airline flight from London, England to
Auckland in New Zealand. There is a history of post operative deep vein
thrombosis 2 years ago. You advise her not to take excessive alcohol or
sleeping tablets and regularly flex ankles to contract calf muscles
In
this patient what further action would you recommend?
a)
No
further action
b)
Aspirin before flight
c)
Warfarin
d)
Low
molecular weight heparin
e)
Compression stocking
Answer: e)
Recommendations to prevent DVT during airline flight lasting > 6hours
Low
risk
ü
No
history of DVT or PE
ü
No
surgery in the previous 4 weeks
ü
No
other risk factors to indicate moderate/high risk
Recommendation
ü
Do not
take excessive alcohol or sleeping tablets
ü
Regularly flex ankles to contract calf muscles
Moderate risk
ü
Previous history of DVT or PE
ü
Surgery under general anaesthesia lasting more than 30 minutes in the previous
2
months
but not in the last 4 weeks
Recommendation
ü
Do not
take excessive alcohol or sleeping tablets
ü
Regularly flex ankles to contract calf muscles
ü
Wear
compression stocking
High risk
ü
Surgery under general anaesthesia lasting more than 30 minutes in previous 4
weeks
Recommendation
ü
Precautions as for low to moderate plus
ü
Single
injection of low molecular weight heparin before departure
Other conditions
ü
History of DVT (or PE)
ü
Additional major risk factors for
ü
Recurrence of thrombosis (cancer etc )
Recommendation
ü
LMWH
Recent DVT (or PE)
ü
On
anticoagulant treatment low risk
ü
Within
2 weeks of a new DVT or PE risk greater
Plaster casts
ü
Consider split cast to reduce the risk of compression
Aspirin
ü
No
evidence to support use of aspirin in any category
Revision Tip
Revise
DVT KEYS to SUCCESS in Medicine page
169-171
