Saphenion protocol travel thrombosis: Dr. Ulf Th.Zierau, PD Dr. W.Lahl
Current Topic: Saphenion Protocol Travel Thrombosis
Recommendations for effective prophylaxis
Year-round oversea flights z. for example, booked to Thailand, Australia, Brazil or the US-long-distance travel is the trend. New in this group is elderly patients, who actually travel by cruise ship but first have to fly longer distances to the departure port by plane. This group of patients has not yet been accurately recorded in scientific research that is part of the subject. However, from a vascular surgical point of view, it can be assumed that in this group of long-distance tourists, significantly higher risks for travel thrombosis can be found. That’s why we put together the Saphenion Protocol Prophylaxis Travel Thrombosis.
In the past, especially in the summer weeks and in the early autumn we had quite a few patients who asked for our advice. Or they came to us with an, in the holiday country or on the cruise ship started inadequate thrombosis therapy. However, we now see these patients with us all year round. Every week we receive inquiries about the problem of travel thrombosis – every month we have to initiate or continue appropriate therapy. Thus, the question arises:
Is the number of travel thromboses increasing? From our experience in the two Vein Care Centers Berlin and Rostock: YES!
Risk venous thrombosis, risk pulmonary embolism
An important cause of venous pulmonary embolism is deep vein thrombosis. It is caused by the formation of a blood clot in the leg veins, which impairs blood flow. The patient notices the thrombosis due to pain in the leg. It swells and is pressure-sensitive, heavy and also red. Most of the time, traveling thrombosis begins in the superficial or deep veins of the lower leg, with venous pressure also highest here – between 90 and 110 mmHg.
Thus, all travelers who are long in the airplane, car or even in the long – distance bus in cramped conditions, potentially exposed to a risk of thrombosis. Without an appropriate history of the disease, the risk is low (1: 5000), but if thrombosis or phlebitis in the family known or surgery before travel has taken place, thrombosis is not uncommon. If there is a pregnancy or varicose veins, the risk increases to 8 -12 times! The highest risk is in women shortly after delivery.
Of particular note is the superficial venous thrombosis (OVT), formerly known as phlebitis. This often is affecting only a small side branch, showing redness and painful hardening of the vein over a short distance of 2-5 cm. But a patient can not assess what is already happening in depth. Has the OVT already expanded into a connecting vein or a muscle vein, or perhaps already into the deep vein? However, these questions are acute – and they can only be clarified by an immediate ultrasound examination. In the airplane or on the ship, however, this is rarely feasible – therefore a therapy ex juvantibus (from the experience of the effect out) initially makes sense without diagnostics.
See also our therapy recommendations for superficial vein thrombosis:
Standing blood column in the deep venous system
Long-distance travel favors such a problem because the blood during long sitting can not circulate freely in the leg as otherwise. The symptoms can occur relatively soon after the trip, but also up to four weeks later. This basically applies to all means of travel, including trips by car or bus. However, the risk is especially high for longer flights. We, physicians, suspect that in addition to the limited freedom of movement and the special conditions in the aircraft cabin with low pressure and low oxygen supply are involved. It is crucial in venous thrombosis that the venous column of blood „stands“ in the veins of the leg, especially in the lower leg veins for a long time. This then triggers a coagulation cascade, which initially begins with a local closure of the vein and then continues in the absence of therapy in the deep veins in the ascending direction. Pulmonary embolism risk increases dramatically to 60% when thrombosis reaches the knee vein. The author has just experienced this mechanism himself.
Preventive therapy concepts
Several studies have been analyzed for the Saphenion Protocol Prophylactic Travel Thrombosis. Overall, however, the data in the field of travel thrombosis is still quite weak. There are few studies on the prevention of travel thrombosis, so most recommendations are based on expert judgment. This results in different guideline recommendations internationally. While British experts recommend calf-length compression stockings for a whole range of patients in addition to general measures, the German guideline of the Association of Scientific Medical Societies (AWMF) points out that in healthy persons, due to the low risk, generally no further precautions are taken necessarily. The US Guideline explicitly opposes the use of anticoagulants to prevent travel thrombosis. British and German doctors recommend – as we do – for travelers with high risk after individual consideration, a single dose of low molecular weight heparin. Especially in the US, travelers generally favor ASS / ASPIRIN and similar, over-the-counter, low-cost platelet aggregation inhibitors as thrombosis prophylaxis.
However, in our opinion, this therapy is largely ineffective. As early as 1988, the author pointed out in his dissertation at the Humboldt University Berlin, that these substances in the venous system do not achieve any significant antithrombotic effect. This statement is currently confirmed by many authors.
Saphenion Protocol Prophylaxis Travel Thrombosis
We recommend for the travel season, whether bus, plane or long drive the following prophylaxis:
Wearing compression stockings class 1 – 2 on flights of more than 2 hours duration for patients with known risk factors and existing varicose veins.
A single injection of heparin preparation prior to travel in patients with already known deep vein thrombosis or superficial venous thrombosis (previously: phlebitis) – in these patients, heparin prophylaxis is recommended under current treatment criteria, as the risk of deep venous thrombosis increases significantly.
The administration of heparin to pregnant women and mothers immediately after delivery must be discussed on an individual basis.
And it should definitely be a rehabilitation of the venous system if already surface venous thrombosis has occurred. Here is a whole range of endovenous therapy methods available. These are already applicable 6-8 weeks after an acute OVT. Radical-surgical therapy is no longer necessary.