| Trombosis del viajero: revisión sistemática |
Traveler's thrombosis: a systematic review.
Ansari MT, Cheung BM, Qing Huang J, Eklof B, Karlberg JP.
Clinical Trials Centre, Faculty of Medicine, The University of Hong Kong.
J Travel Med. 2005 May-Jun;12(3):142-54.
Abstract
BACKGROUND: Anecdotal evidence suggests a possible link between travel and venous thromboembolism (VTE). We systematically evaluated the evidence from observational studies. METHODS: We searched studies evaluating the risk of venous thrombosis in relation to traveling from MEDLINE and EMBASE up tp March 2004, together with a hand search of reference lists from retrieved literature, and we contacted some of the experts. Observational studies estimating the risks of VTE and isolated calf vein thrombosis were eligible. Methodologic quality was assessed based on prior criteria, and meta-analysis was considered where applicable. RESULTS: A total of 194 English-language publications were initially identified. Sixteen studies were included: 9 case-control, 2 prospective controlled, and 5 other observational studies. They differed drastically in study designs, selection of controls where applicable, mode and duration of travel, and subtypes of VTE under consideration. Ten studies concluded that travel, mostly through air and of prolonged duration, is a risk factor for venous thrombosis and/or pulmonary embolism, and the risk increases for passengers with preexisting venous thrombosis risk factors. Outcomes examined ranged from asymptomatic isolated calf muscle vein thrombosis to severe fatal pulmonary embolism. Conclusions: Current literature is controversial over any association between travel and VTE, and although the quality and power of these studies have been variable, studies of higher quality have shown a strong and significant association between prolonged air travel and VTE. No conclusions could be drawn about other modes of transportation. Since VTE is a disease of multifactorial causation, those with preexisting VTE risk factors are most vulnerable.
http://onlinelibrary.wiley.com/doi/10.2310/7060.2005.12303/pdf
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| Viajes aéreos y trombosis |
Air travel and thrombosis.
Chee YL, Watson HG.
Department of Haematology, Aberdeen Royal Infirmary, Aberdeen, UK.
Br J Haematol. 2005 Sep;130(5):671-80.
Abstract
The current literature suggests a weak association between long-distance travel and the development of asymptomatic venous thromboembolism (VTE). Most of the data available relate to air travel and suggest that the risk is largely confined to asymptomatic calf vein thrombosis in passengers with additional risk factors for VTE, travelling for more than 8 h. The risk of both symptomatic and fatal pulmonary embolism (PE) is very small. The causal role of travel-related factors (e.g. stasis, dehydration, cramped seats and hypobaric hypoxia) is not yet proved but, given the plausible risk-free benefit, all passengers should be advised to maintain adequate hydration and exercise. There is currently no evidence for 'routine' thromboprophylaxis using stockings or drugs. In passengers with additional risk factors for VTE, thromboprophylaxis in the form of below-knee graduated compression stockings (providing 15-30 mmHg at the ankle) and/or prophylactic dose low-molecular-weight heparin may be considered. The evidence does not support the use of aspirin, which is associated with a significant rate of adverse gastrointestinal effects
http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2141.2005.05617.x/pdf
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| Guías relacionadas a la trombosis relacionada a los viajeros |
Guidelines on travel-related venous thrombosis
Henry G. Watson1 and Trevor P. Baglin
Department of Haematology, Aberdeen Royal Infirmary, Aberdeen, and 2Department of Haematology, Adenbrookes Hospital,
Cambridge, UK.
British Journal of Haematology, 152, 31-34
Summary
* Long duration travel is a weak risk factor for the development of venous thromboembolism (VTE). The incidence of VTE after flights of >4 h is 1 in 4656 and for flights of more than 8 h in low and intermediate risk flyers is around 0Æ5%. * Severe symptomatic pulmonary embolism in the period immediately after travel is extremely rare after flights of <8 h. In flights over 12 h the rate is 5 per million. * VTE may be attributable to travel if it occurs up to 8 weeks following the journey. * The risk of travel-related thrombosis is higher in individuals with pre-existing risk factors for the development of VTE. * There is no evidence for an association between dehydration and travel-associated VTE and so whilst maintaining good hydration is unlikely to be harmful it cannot be strongly recommended for prevention of thrombosis (recommendation grade 2, level of evidence, B). * There is indirect evidence that maintaining mobility may prevent VTE and, in view of the likely pathogenesis of travel-related VTE, maintaining mobility is a reasonable precaution for all travellers on journeys over 3 h (2B). * Global use of compression stockings and anticoagulants for long distance travel is not indicated (1C). * Assessment of risk should be made on an individual basis but it is likely that recent major surgery (within 1 month), active malignancy, previous unprovoked VTE, previous travel-related VTE with no associated temporary risk factor or presence of more than one risk factor identifies those travellers at highest thrombosis risk (1C). * Travellers at the highest risk of travel-related thrombosis undertaking journeys of >3 h should wear well fitted below knee compression hosiery (2B). * Where pharmacological prophylaxis is considered appropriate, anticoagulants as opposed to anti-platelet drugs are recommended based on the observation that, in other clinical scenarios, they provide more effective thromboprophylaxis.Usual contraindications to any form of thromboprophylaxis need to be borne in mind (2C).
http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2141.2010.08408.x/pdf
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