People who travel long distances, whether by air, car, bus, or train, may be at risk for blood clots

More than 300 million people travel on long-distance flights (generally more than four hours) each year.

Blood clots, also called deep vein thrombosis (DVT), can be a serious risk for some long-distance travelers. Most information about blood clots and long-distance travel comes from information that has been gathered about air travel. However, anyone traveling more than 4 hours, whether by air, car, bus, or train, can be at risk for blood clots.

Blood clots can form in the deep veins (veins below the surface that are not visible through the skin) of your legs during travel because you are sitting still in a confined space for long periods of time. The longer you are immobile, the greater your risk is of developing a blood clot. A DVT occurs when a blood clot forms in the deep veins of the legs. At times the blood clot may dissolve on its own. However, a serious health problem can occur when a part of the blood clot breaks off and travels to the lungs causing a blockage. This is called a pulmonary embolism (PE), and it may be fatal. The good news is there are things you can do to protect your health and reduce your risk of blood clots during a long-distance trip.

Understand what can increase your risk for blood clots

Even if you travel a long distance, the risk of developing a blood clot is generally very small. Your level of risk depends on the duration of travel as well as whether you have any other risks for blood clots. Most people who develop travel-associated blood clots have one or more other risks for blood clots, such as:

• Older age (risk increases after age 40)
• Overweight or obesity
• Recent surgery or injury (within 3 months)
• Use of estrogen-containing contraceptives (for example, birth control pills, rings, patches)
• Hormone replacement therapy (medical treatment in which hormones are given to reduce the effects of menopause)
• Pregnancy and the postpartum period (up to 3 months after childbirth)
• A previous blood clot
• An inherited blood clotting disorder
• Family history of blood clots
• Active cancer or recent cancer treatment
• Certain other long-term conditions, such as heart or lung conditions, or diabetes
• Limited mobility (for example, a leg cast)
• Catheter placed in a large vein
• Varicose veins
• The combination of long-distance travel with one or more of these risks may increase the likelihood of developing a blood clot. The more risks you have, the greater your chances of experiencing a blood clot. If you plan on traveling soon, talk with your doctor to learn more about what you can do to protect your health. The most important thing you can do is to learn and recognize the symptoms of blood clots.

Recognize the symptoms

Deep vein thrombosis (DVT)

About half of people with DVT have no symptoms at all. The following are the most common symptoms of DVT that occur in the affected part of the body (usually the leg or arm):

• Swelling of your leg or arm
• Pain or tenderness that you can’t explain
• Skin that is warm to the touch
• Redness or discoloration of the skin
  
  If you have any of these symptoms, contact your doctor as soon as possible.

Pulmonary embolism (PE)

You can have a PE without any symptoms of a DVT. Symptoms of a PE can include:

• Difficulty breathing
• Faster than normal or irregular heartbeat
• Chest pain or discomfort, which usually worsens with a deep breath or coughing
• Anxiety
• Cough or coughing up blood
• Lightheadedness, or fainting
  
  If you have any of these symptoms, seek medical help immediately.

  Anticoagulants

  Anticoagulants (commonly referred to as “blood thinners”) are the medications most commonly used to treat DVT or PE. Although called blood thinners, these medications do not actually thin the blood. They reduce the ability of the blood to clot, preventing the clot from becoming larger while the body slowly reabsorbs it, and reducing the risk of further clots developing.

  The most frequently used injectable anticoagulants are:

  • Unfractionated heparin (injected into a vein),
  • Low molecular weight heparin (LMWH) (injected under the skin), and
  • Fondaparinux (injected under the skin).

  Anticoagulants that are taken orally (swallowed) include:

  • Warfarin
  • Dabigatran
  • Rivaroxaban
  • Apixaban
  • Edoxaban

  All of the anticoagulants can cause bleeding, so people taking them have to be monitored to prevent unusual bleeding.

  Thrombolytics

  Thrombolytics (commonly referred to as “clot busters”) work by dissolving the clot. They have a higher risk of causing bleeding compared to the anticoagulants, so they are reserved for severe cases.

  Inferior vena cava (IVC) filter

  When anticoagulants cannot be used or don’t work well enough, a filter can be inserted inside the inferior vena cava (a large vein that brings blood back to the heart) to capture or trap an embolus (a clot that is moving through the vein) before it reaches the lungs.

  Thrombectomy/Embolectomy

  In rare cases, a surgical procedure to remove the clot may be necessary. Thrombectomy involves removal of the clot in a patient with DVT. Embolectomy involves removal of the blockage in the lungs caused by the clot in a patient with PE.