Blood Clot DVT and Flying Long Haul

[siftasam]

I was diagnosed with a blood clot in my left calf a year ago. My doctors clearly spelled out the dangers.

 

I want to fly on holiday to Switzerland next July for a good walking holiday. I can deal with the hiking but I am naturally concerned about the flying. It will be about a 12 hour flight non-stop Swiss International from BKK to Zurich. From Zurich I can take my time.

 

Reluctantly (!), I am willing to spend the extra reservation money on the single Throne Seats on the flights. The legroom and privacy will help although being 179cms tall and around 89 kilos doesn't help.

 

I took Eliquis from my doctor, I've stopped now as the leg feels OK according to him and me. I'm walking more, taking a little more exercise, and improving my diet. I have more Eliquis I can take before the trip.

 

Any thoughts or personal experiences of DVT? I am 76 years old and will be travelling alone.

[Sheryl]

Get compression stockings and wear them on the flight. And get up and walk frequently mid-air.

[Aussieroaming]

I worked with a guy who had DVT when we were doing a job in Zambia and flying back to Australia every 6 weeks. He got bad DVT and they put him on blood thinners and he kept working.

 

6 months after he first got it he was in the transit area between flights in Germany and he dropped dead of a massive heart attack in the transit area.

 

He was about 55 - 60 at the time. Make sure you take all precautions possible,the DVT is unforgiving.

[Siamkid]

I had extremely chronic DVT eleven years ago.  My doctor gave me Warfarin for months and then took me off of it.  My next check up showed my INR was too high so I was prescribed a bigger dose of Warfarin. My doctor didn't know what else to do.  Real long story short is I ended up at Bumrungrad at the Horizon Cancer Clinic and Dr. Harit gave me a complete physical and said he had never seen a case as bad as mine. He prescribed Xarelto, one pill a day for six months. Back then Xarelto was 800 Baht per pill but it got the job done !!! All up I spent 20 months under medical supervision.  I wear a full length compression stocking daily.  I have had two doctors recommend that if I were to fly in excess of 3 hours I should inject myself with Heparin every 3 hours during a long haul flight along with drinking a lot of water, compression stocking and walk around the plane frequently.  I hope this information is of some help to you !!!

[mrmicbkktxl]

13 minutes ago, Siamkid said:

I had extremely chronic DVT eleven years ago.  My doctor gave me Warfarin for months and then took me off of it.  My next check up showed my INR was too high so I was prescribed a bigger dose of Warfarin. My doctor didn't know what else to do.  Real long story short is I ended up at Bumrungrad at the Horizon Cancer Clinic and Dr. Harit gave me a complete physical and said he had never seen a case as bad as mine. He prescribed Xarelto, one pill a day for six months. Back then Xarelto was 800 Baht per pill but it got the job done !!! All up I spent 20 months under medical supervision.  I wear a full length compression stocking daily.  I have had two doctors recommend that if I were to fly in excess of 3 hours I should inject myself with Heparin every 3 hours during a long haul flight along with drinking a lot of water, compression stocking and walk around the plane frequently.  I hope this information is of some help to you !!!

Where to get Heparin?

[Siamkid]

My doctor would prescribe Heparin. Bach then it was 3,000 Baht per injection. To be injected into fatty tissue every three hours throughout the duration of the flight.  Please keep in mind that this information is about 10 years old....

[NancyL]

Was the heparin in an injector pen?  That's the only way I can see how it would cost 3,000 baht/injection.

 

I've injected myself with heparin and even with U.S. prices, it was very inexpensive, but I was loading an insulin syringe and jabbing it into the skin of my belly fat.  The first few times, I had to work up my courage, with actually pushing down the syringe contents being the hard part.

 

It was a real thrill to do it in an airplane toilet the 2nd or 3rd time the situation arose (with people knocking at the door, wondering why I was taking so long)

[Siamkid]

I never needed to actually buy injectable Heparin as I haven't traveled in excess of 3 hours on a plane since I was diagnosed 11 years ago.  When I was first diagnosed my doctor gave me one injection per day for the first 9 days, After that I was on Warfarin for several months before going to see Dr. Harit who prescribed Xarelto.  My local doctor advised me to use prefilled Heparin injections every three hours for the duration of the flight if it exceeded 3 hours.

[DrJoy]

Tinzaparin helps a lot

[Sjoerd]

1 hour ago, Siamkid said:

I had extremely chronic DVT eleven years ago.  My doctor gave me Warfarin for months and then took me off of it.  My next check up showed my INR was too high so I was prescribed a bigger dose of Warfarin. My doctor didn't know what else to do.  Real long story short is I ended up at Bumrungrad at the Horizon Cancer Clinic and Dr. Harit gave me a complete physical and said he had never seen a case as bad as mine. He prescribed Xarelto, one pill a day for six months. Back then Xarelto was 800 Baht per pill but it got the job done !!! All up I spent 20 months under medical supervision.  I wear a full length compression stocking daily.  I have had two doctors recommend that if I were to fly in excess of 3 hours I should inject myself with Heparin every 3 hours during a long haul flight along with drinking a lot of water, compression stocking and walk around the plane frequently.  I hope this information is of some help to you !!!

If your INR is too high you should eat less Warfarin; not more. I had DVT and brainbleeding, because one from the 4 bloodvanes in the neck was locked..;chek INR weekly at home.  My advice is too use warfarine, check INR reguarly and special short time before fly (should be around 3.0-3.5). And.. ofcourse the other precautions told by other people as walking in the plane etc..

[richard_smith237]

Following a football injury I had a DVT and PE in my early 30’s... 

 

Since then, under with Doctors advice I self administered a 40mg/0.4ml Clexane injection (Heparin) before any flight longer than 4 hours. 

 

See your haematologist / cardiologist and seek their advice.

 

Compression socks are also effective and minimise your risk of contracting a DVT - its also good to wear the compression socks / calf compression skins when sitting around not doing much (I wear them at work quite regularly or when lazing around at home). 

 

Statistically 1 in 4 people will have a ’thrombotic’ episode / event in Their life - it makes sense for anyone to wear the compression socks on any flight, long journey or whenever sitting for long periods of time. 

 

 

 

[richard_smith237]

48 minutes ago, NancyL said:

Was the heparin in an injector pen?  That's the only way I can see how it would cost 3,000 baht/injection.

 

I've injected myself with heparin and even with U.S. prices, it was very inexpensive, but I was loading an insulin syringe and jabbing it into the skin of my belly fat.  The first few times, I had to work up my courage, with actually pushing down the syringe contents being the hard part.

 

It was a real thrill to do it in an airplane toilet the 2nd or 3rd time the situation arose (with people knocking at the door, wondering why I was taking so long)

The Clexane pens are pre-loaded.

It takes 20 seconds to inject, the needle self retracts. 

 

Extremely quick, extremely simple. 

 

Clexane can be purchased / ordered from many Pharmacies in Thailand. 

[richard_smith237]

17 minutes ago, Sjoerd said:

If your INR is too high you should eat less Warfarin; not more. I had DVT and brainbleeding, because one from the 4 bloodvanes in the neck was locked..;chek INR weekly at home.  My advice is too use warfarine, check INR reguarly and special short time before fly (should be around 3.0-3.5). And.. ofcourse the other precautions told by other people as walking in the plane etc..

This is why Warfarin is considered ‘old tech’....  Drugs like Rivoroxaban (Xarelto) have superseded it and are far safer to take (under medical advice of course). 

 

The only issue with Rivoroxaban is that unlike Warfarin which can be reversed with Vitamin-K (injection) the ‘thinning’ effects of Rivoroxaban cannot be reversed.

 

 

 

 

[Sjoerd]

4 minutes ago, richard_smith237 said:

This is why Warfarin is considered ‘old tech’....  Drugs like Rivoroxaban (Xarelto) have superseded it and are far safer to take (under medical advice of course). 

 

The only issue with Rivoroxaban is that unlike Warfarin which can be reversed with Vitamin-K (injection) the ‘thinning’ effects of Rivoroxaban cannot be reversed.

 

 

 

 

My experience with Acenacoumarol (as Warfarin) is about 11 years positive/safe if check INR as needed; example weekly. You mentioned already the postive side with Vitamin-K if need to cancel the thinning effect quickly; example for a quick operation.. My hematologist in a specialised hospital in Holland still advice me not to change to the newer medication.. Maybe the situations can be different..

...On the topic I just reacted that you should eat less instead of more when your INR is too high..

[richard_smith237]

5 hours ago, siftasam said:

Any thoughts or personal experiences of DVT? I am 76 years old and will be travelling alone.

Thoughts... 

 

1) Take a followup Doppler Ultra-sound to ensure there is no remnant clotting - i.e. your therapeutic interval is complete.

 

2) Wear graduated compression socks (decent ones, not the flight socks from boots which are better than nothing, but not that good either) ... I’ve found Skins to be very decent, but there are others out there. The Pharmacies of Major hopitals make stock decent graduated compression socks. 

 

3) Discuss with your Dr. / Haematologist the possibility of taking a preventative medication (i.e. Xarelto) 

 

4) discuss with your Dr. / Haematologist the possibility of taking preventative blood thinning injection (for the flight only - of course, not at the same time as taking any other blood thinning medication). 

[sandyf]

1 hour ago, mrmicbkktxl said:

Where to get Heparin?

It was about 30 years after Heparin was introduced they discovered it could affect the platelets causing the "very rare blood clots" that became a concern with the covid vaccines. I thought it had been discontinued.

[richard_smith237]

1 minute ago, Sjoerd said:

14 minutes ago, richard_smith237 said:

This is why Warfarin is considered ‘old tech’....  Drugs like Rivoroxaban (Xarelto) have superseded it and are far safer to take (under medical advice of course). 

 

The only issue with Rivoroxaban is that unlike Warfarin which can be reversed with Vitamin-K (injection) the ‘thinning’ effects of Rivoroxaban cannot be reversed.

 

 

 

 

Expand  

My experience with Acenacoumarol (as Warfarin) is about 11 years positive/safe if check INR as needed; example weekly. You mentioned already the postive side with Vitamin-K if need to cancel the thinning effect quickly; example for a quick operation.. My hematologist in a specialised hospital in Holland still advice me not to change to the newer medication.. Maybe the situations can be different..

...On the topic I just reacted that you should eat less instead of more when your INR is too high..

I took Wafarin for 6 months after a DVT & PE... I bought my own INR test kit (expensive !) and tested regularly, sometimes a couple of times per-day.... 

 

With a targeted therapeutic INR reading of between 2 and 3 the swing in INR throughout the week and throughout the day is quite incredible from readings as low as 1 and up to 6 when trying to be as consistent as possible. 

 

I charted the results against diet etc... the Dr was quite amazed at the self study, the results being significantly impacted by types of food I ate and even as much water as I drank in the day time.

 

Any booze sent the reading haywire... high, then low... (which is why booze is to be avoided).

 

I even went skiing and carried a vial of Vitamin-K just incase I wiped out and broke a leg etc... 

 

-------

 

Having had a DVT and PE there is a higher probability of having another within 10 years is 30%...  

I had another 9 years later !! (not related to travel)...  and stopped taking Clexane for flights and was prescribed Rivoxoaban (Xarelto) for life. 

 

The only reason I wasn’t prescribed Rivoroxaban after the first event was because it was too new and was only FDA approved at the time in Canada for post hip-operations recovery (to avoid clotting). 

 

I may be wrong, but suspect any ’fresh’ cases will always be prescribed something similar to Rivoroxaban rather than Warfarin as its considered dated. 

 

[richard_smith237]

11 minutes ago, sandyf said:

It was about 30 years after Heparin was introduced they discovered it could affect the platelets causing the "very rare blood clots" that became a concern with the covid vaccines. I thought it had been discontinued.

Thats Thrombotic thrombocytopenia.... i.e. excessive blood thinning causing the platelets in the blood to fall out of suspension and thus cause a clot.

 

This is a possibility with all blood thinning medication.

 

Clexane was not discontinued at all - it very much remains a life saving drug when used correctly. 

 

 

[Lacessit]

If the OP was to say his flight is for an emergency of some kind, I'd say the risk is worth it. For a holiday, no.

 

I don't have DVT. My policy on a flight is to get up and walk around every 20 minutes, with some stretching exercise. Accordingly, I always purchase aisle seating.

 

There are plenty of hikes in Thailand, or the OP could simply walk up 20 flights of condo stairs for the exercise.

[still kicking]

6 hours ago, Sheryl said:

Get compression stockings and wear them on the flight. And get up and walk frequently mid-air.

I wear them every day not only on flights

[richard_smith237]

13 minutes ago, Lacessit said:

If the OP was to say his flight is for an emergency of some kind, I'd say the risk is worth it. For a holiday, no.

 

I don't have DVT. My policy on a flight is to get up and walk around every 20 minutes, with some stretching exercise. Accordingly, I always purchase aisle seating.

 

There are plenty of hikes in Thailand, or the OP could simply walk up 20 flights of condo stairs for the exercise.

Lets no over-egg the pudding..... the risk is perfectly manageable particularly with medical advice. 

 

The Op knowing he’s at risk quite likely to be in a far safer condition that someone who is completely unaware of the risk of DVT whilst flying or even remaining still or sat for long periods of time. 

 

Those sitting in offices for long durations of the day are also at high risk... etc etc... its not just flying. 

 

 

 

 

[Scott]

A post making unsubstantiated claim and replies reported and removed.

 

[siftasam]

Such tremendously helpful and knowledgeable responses! I thank you all. I'll surely reply as soon as I digest all the information.

 

I am medically ignorant partly because (and this is no excuse!) my health has always been good. Although 76, this year's Co-Vid was the first time that I've spent a single night in hospital; hence, I've not bothered with the expense of health insurance for over 35 years. How impossible or impossibly expensive it would be now! I've only ever had two operations; relatively simple ones in out-patients.

 

I'm tempted then to go, particularly as my doctor voiced no objections after I told him about my Switzerland idea; in fact, he's recommended me to do more walking (which I like). He did warn me not to drink any alcohol on the flight. I'm surprised that he's never mentioned compression socks! My heart has been tested. it's always been strong  even after Co-Vid. He's never mentioned any other medication.

[Lacessit]

2 hours ago, richard_smith237 said:

Lets no over-egg the pudding..... the risk is perfectly manageable particularly with medical advice. 

 

The Op knowing he’s at risk quite likely to be in a far safer condition that someone who is completely unaware of the risk of DVT whilst flying or even remaining still or sat for long periods of time. 

 

Those sitting in offices for long durations of the day are also at high risk... etc etc... its not just flying. 

 

 

 

 

You may be right; however, at age 76 the risk may be higher than that for a younger person.

At my age, I do tend to over-egg every pudding. Better than a situation arising like the curate's egg.

[Lorry]

1. Drink a lot on the flight. A lot means: you have to pee every 2 hours.  Urine has the color of white wine (not the color of beer). 

Almost everybody on a plane doesn't drink enough and is dehydrated. A lot really means a lot.

2. Keep the leg elevated,  i.e. fly business class. 

3. Wear graduated (explained by another poster) compression stockings. Not the cheap stockings the airlines sell.

4. Walk a lot during the flight.  Every 20 minutes, as Lacessit said.

Flight attendants won't like it. Ignore them.  It's your health, not theirs. 

5. At check-in, take one of your Eliquis. OR take a prefilled injection of  Clexane 40mg as described by others (only once, shortly before the flight, not every 3 hours). Not both. No Xarelto ( you said you still have Eliquis), no Warfarin.

 

[bangkok19]

If the sitting for long periods is your main concern..  fly business class for the extra leg room so that you can elevate your leg(s),  and preferably on an Emirates A380 so that you can stand up (for longer periods) at the "bar".

You don't have to drink alcohol..  just some 'calf raises' and 'conversation'.

You'll be amazed how quickly the time will fly.  

[hotchilli]

18 hours ago, Sheryl said:

Get compression stockings and wear them on the flight. And get up and walk frequently mid-air.

Good advice, take a couple of normal aspirin before the flight... thin the blood a little.

[sandyf]

16 hours ago, richard_smith237 said:

Thats Thrombotic thrombocytopenia.... i.e. excessive blood thinning causing the platelets in the blood to fall out of suspension and thus cause a clot.

 

This is a possibility with all blood thinning medication.

 

Clexane was not discontinued at all - it very much remains a life saving drug when used correctly. 

 

 

Back in 2008 my doctor in the UK wanted to put me on anticoagulants. He said heparin wasn't used any more and warfarin was the only option. Depends what he meant by that.

I declined his offer and remained on aspirin until 2016 when I started the apixaban.

[sandyf]

17 hours ago, richard_smith237 said:

I charted the results against diet etc... the Dr was quite amazed at the self study, the results being significantly impacted by types of food I ate and even as much water as I drank in the day time.

 

Any booze sent the reading haywire... high, then low... (which is why booze is to be avoided).

Quite. My younger brother was on warfarin for life following a triple bypass in his 40s. He was a borderline alcoholic and lost the will to live with the continual blood monitoring. Died about 6 years ago in his 60s.

[Sheryl]

4 hours ago, hotchilli said:

Good advice, take a couple of normal aspirin before the flight... thin the blood a little.

I always take a single dose of low dose (81mg) aspirin before a flight. But for those like OP who are at above average risk, having a history of DVT, should consult their doctors as they may be advised to go on an anticoagulant for some days prior  (and during) trip.