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 For women with additional risk, doctors may recommend compression
stockings and injectable blood thinners while traveling, the authors
write in the Journal of Travel Medicine.
"Both pregnancy and air travel are risk factors for venous
thromboembolism, or a blood clot in the legs or lungs," said senior
author Dr. Leslie Skeith of the University of Calgary, a member of
the CanVECTOR Canadian thrombosis research network.
Blood clots affect about one to two per 1,000 nonpregnant people
each year and are the third leading cause of vascular death after
heart attacks and strokes, the authors note. With more than two
billion passengers flying each year, about 150,000 cases of
travel-related blood clots are diagnosed annually.
Long-distance flights tend to increase the risk by three-fold, yet
travel-related studies either don't include pregnant women or only
include a small number and don't directly investigate how pregnancy
increases the risk.
"There is very little evidence to guide what pregnant and postpartum
women should do to prevent blood clots while traveling," Skeith told
Reuters Health by email.
Skeith and her colleagues review the many factors that play into an
individual's risk for a blood clot, including height, weight, recent
surgery, pregnancy, use of oral contraceptives, hormone replacement
therapy and a family history of clots or diseases that promote
clotting.
With pregnancy in particular, they write, the risk is higher because
of physiological changes, such as slower blood flow and blood vessel
dilation. Pelvic blood vessels may also be compressed as the uterus
grows. Starting in early pregnancy, the body starts to become
hypercoagulable, or more likely to form blood clots. These risks
remain higher until about 12 weeks after giving birth.
Although the average pregnant or postpartum air traveler faces an
increased risk of clots, the absolute risk estimate is low at less
than 1%, the study found.
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Pregnant women with other risk factors, such as inherited blood
problems, obesity and recent surgery, may face a higher blood clot
risk, however. Although the risk depends on individual factors,
women with a history of blood clots tend to have a 4% higher risk
while pregnant, and those with hormonal-associated blood clots tend
to have a 6% higher risk while pregnant.
For most women with a history of blood clots, the risk during air
travel still remains low at just over 1%. At the same time, pregnant
women who face these higher risks should consider using more
extensive blood clot prevention measures while traveling, such as
the injectable blood thinner low-molecular-weight heparin (LMWH).
"It is known that LMWH prophylaxis lowers the risk of recurrent
thrombosis in women with previous venous thromboembolism," said Dr.
Ida Martinelli of the University of Milan, who wasn't involved in
the study.
However, some studies show that certain blood conditions and blood
thinners can lead to complications during delivery, so it's best to
consult a doctor for individual recommendations.
Skeith and colleagues are now studying whether aspirin can prevent
blood clots in postpartum women with risk factors for clots. The
pilot randomized trial, called PARTUM, is expected to start in 2020.
"We desperately need more research to better prevent blood clots in
pregnant and postpartum women," Skeith said. "We recommend talking
to your doctor about different options."
SOURCE: https://bit.ly/34YV2cm Journal of Travel Medicine, online
December 11, 2019.
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