Original Research| Volume 33, ISSUE 2, P169-178, June 2022

Travel-Associated Venous Thromboembolism

Published:March 31, 2022DOI:


      Long-distance travel is assumed to be a risk factor for venous thromboembolism (VTE). However, the available data have not clearly demonstrated the strength of this relationship, nor have they shown evidence for the role of thromboprophylaxis.


      We performed a systematic review of the literature. We also summarized available guidelines from 5 groups.


      We found 18 studies that addressed this question. Based on the data presented in the review, we conclude that there is an association between VTE and length of travel, but this association is mild to moderate in effect size with odds ratios between 1.1 and 4. A dose-response relationship between VTE and travel time was identified, with a 26% higher risk for every 2 h of air travel (P=0.005) starting after 4 h. The quality of evidence for both travel length and thromboprophylaxis was low. However, low-risk prophylactic measures such as graduated compression stockings were shown to be effective in VTE prevention. There is heterogeneity among the different practice guidelines. The guidelines generally concur that no prophylaxis is necessary in travelers without known thrombosis risk factors and advocate for conservative treatment such as compression stockings over pharmacologic prophylaxis.


      We conclude air travel is a risk factor for VTE and that there is a dose relationship starting at 4 h. For patients with risk factors, graduated compression stockings are effective prophylaxis.


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        • Beckman M.G.
        • Hooper W.C.
        • Critchley S.E.
        • Ortel T.L.
        Venous thromboembolism: a public health concern.
        Am J Prev Med. 2010; 38: S495-501
        • Kuipers S.
        • Schreijer A.J.
        • Cannegieter S.C.
        • Buller H.R.
        • Rosendaal F.R.
        • Middeldorp S.
        Travel and venous thrombosis: a systematic review.
        J Intern Med. 2007; 262: 615-634
        • Louvel J.
        [Four cases of phlebitis due to air travel].
        Arch Mal Coeur Vaiss. 1951; 44: 748-749
        • Symington I.S.
        • Stack B.H.
        Pulmonary thromboembolism after travel.
        Br J Dis Chest. 1977; 71: 138-140
        • Kesteven P.L.
        Traveller's thrombosis.
        Thorax. 2000; 55: S32-S36
        • Trujillo-Santos A.J.
        • Jimenez-Puente A.
        • Perea-Milla E.
        Association between long travel and venous thromboembolic disease: a systematic review and meta-analysis of case-control studies.
        Ann Hematol. 2008; 87: 79-86
        • Chandra D.
        • Parisini E.
        • Mozaffarian D.
        Meta-analysis: travel and risk for venous thromboembolism.
        Ann Intern Med. 2009; 151: 180-190
        • Philbrick J.T.
        • Shumate R.
        • Siadaty M.S.
        • Becker D.M.
        Air travel and venous thromboembolism: a systematic review.
        J Gen Intern Med. 2007; 22: 107-114
        • Lehmann R.
        • Suess C.
        • Leus M.
        • Luxembourg B.
        • Miesbach W.
        • Lindhoff-Last E.
        • et al.
        Incidence, clinical characteristics, and long-term prognosis of travel-associated pulmonary embolism.
        Eur Heart J. 2009; 30: 233-241
        • Beam D.M.
        • Courtney D.M.
        • Kabrhel C.
        • Moore C.L.
        • Richman P.B.
        • Kline J.A.
        Risk of thromboembolism varies, depending on category of immobility in outpatients.
        Ann Emerg Med. 2009; 54: 147-152
        • Kuipers S.
        • Cannegieter S.C.
        • Middeldorp S.
        • Robyn L.
        • Buller H.R.
        • Rosendaal F.R.
        The absolute risk of venous thrombosis after air travel: a cohort study of 8,755 employees of international organisations.
        PLoS Med. 2007; 4e290
        • Clarke M.J.
        • Broderick C.
        • Hopewell S.
        • Juszczak E.
        • Eisinga A.
        Compression stockings for preventing deep vein thrombosis in airline passengers.
        Cochrane Database Syst Rev. 2021; 4: CD004002
        • Tsoran I.
        • Saharov G.
        • Brenner B.
        • Barron M.
        • Valdes V.
        • de la Roca Toda M.
        • et al.
        Prolonged travel and venous thromboembolism findings from the RIETE registry.
        Thromb Res. 2010; 126: 287-291
        • Belcaro G.
        • Cornelli U.
        • Dugall M.
        • Hosoi M.
        • Cotellese R.
        • Feragalli B.
        Long-haul flights, edema, and thrombotic events: prevention with stockings and Pycnogenol supplementation (LONFLIT Registry Study).
        Minerva Cardioangiol. 2018; 66: 152-159
        • Hitos K.
        • Cannon M.
        • Cannon S.
        • Garth S.
        • Fletcher J.P.
        Effect of leg exercises on popliteal venous blood flow during prolonged immobility of seated subjects: implications for prevention of travel-related deep vein thrombosis.
        J Thromb Haemost. 2007; 5: 1890-1895
        • Al-Hameed F.M.
        • Al-Dorzi H.M.
        • Abdelaal M.A.
        • Alaklabi A.
        • Bakhsh E.
        • Alomi Y.A.
        • et al.
        The Saudi clinical practice guideline for the prophylaxis of venous thromboembolism in long-distance travelers.
        Saudi Med J. 2017; 38: 101-107
        • Schunemann H.J.
        • Cushman M.
        • Burnett A.E.
        • Kahn S.R.
        • Beyer-Westendorf J.
        • Spencer F.A.
        • et al.
        American Society of Hematology 2018 guidelines for management of venous thromboembolism: prophylaxis for hospitalized and nonhospitalized medical patients.
        Blood Adv. 2018; 2: 3198-3225
        • Kahn S.R.
        • Lim W.
        • Dunn A.S.
        • Cushman M.
        • Dentali F.
        • Akl E.A.
        • et al.
        Prevention of VTE in nonsurgical patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines.
        Chest. 2012; 141: e195S-226S
        • Watson H.G.
        • Baglin T.P.
        Guidelines on travel-related venous thrombosis.
        Br J Haematol. 2011; 152 (31–4)
        • ACOG Committee Opinion No
        746 summary: air travel during pregnancy.
        Obstet Gynecol. 2018; 132 (533–4)
        • Schreijer A.J.
        • Cannegieter S.C.
        • Doggen C.J.
        • Rosendaal F.R.
        The effect of flight-related behaviour on the risk of venous thrombosis after air travel.
        Br J Haematol. 2009; 144 (425–9)
        • Kuipers S.
        • Venemans-Jellema A.
        • Cannegieter S.C.
        • van Haften M.
        • Middeldorp S.
        • Buller H.R.
        • et al.
        The incidence of venous thromboembolism in commercial airline pilots: a cohort study of 2630 pilots.
        J Thromb Haemost. 2014; 12 (1260–5)
        • MacCallum P.K.
        • Ashby D.
        • Hennessy E.M.
        • Letley L.
        • Martin J.
        • Mt-Isa S.
        • et al.
        Cumulative flying time and risk of venous thromboembolism.
        Br J Haematol. 2011; 155 (613–9)
        • Pietrzyk W.S.
        Air travel-related symptomatic deep venous thrombosis in cruise ship passengers.
        Int Marit Health. 2016; 67: 66-71