This handout is for travel-associated dvt (long-haul flight or train >4 h). Your care team identified this based on: unilateral leg swelling, calf pain, or whole-leg swelling within hours to ~4 weeks of long-haul travel >4 h (flight or train) — pretest probability for travel-associated dvt.
Other reasons your team may use this plan: documented flight or continuous transport >4 h within the prior 4 weeks (peak risk window per lonflit) — anchor the provoking factor; new pleuritic chest pain, dyspnea, syncope, or hemoptysis within 4 weeks of long-haul travel — concurrent pe screen indicated (perc fail in this context; ctpa if wells > 4); compression us showing proximal dvt in patient with recent travel history — confirm and treat as provoked vte.
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| apixaban | 10 mg BID × 7 d → 5 mg BID | PO | BID × 3 months total then STOP | AMPLIFY (Agnelli NEJM 2013 PMID 23808982) — apixaban first-line; ACCP 2021 strong recommendation; provoked-by-reversible-factor → 3 mo sufficient |
| rivaroxaban | 15 mg BID × 21 d → 20 mg daily with food | PO | BID then daily × 3 months total then STOP | EINSTEIN-DVT (Bauersachs NEJM 2010 PMID 21128814) — non-inferior; common alternative DOAC |
| enoxaparin | 1 mg/kg SC BID; reduce to 1 mg/kg daily if CrCl <30 | SC | BID × 5-10 d as bridge to warfarin, OR single 40 mg dose pre-flight for high-risk prevention | ASH 2020 (PMID 33007077); Watson + Baglin 2011 — single LMWH dose 2-4 h pre-flight for high-risk patients (prior VTE, active cancer) |
| edoxaban | 60 mg PO daily (30 mg if CrCl 15-50, weight ≤60 kg, or with strong P-gp inhibitor) after 5-10 d LMWH bridge | PO | daily × 3 months total then STOP | Hokusai-VTE (Büller NEJM 2013 PMID 23991958) — edoxaban after LMWH lead-in non-inferior to warfarin |
| warfarin | 5 mg daily; INR target 2-3 | PO | daily × 3 months total then STOP | TRAPS (Pengo Blood 2018 PMID 30002145) — warfarin > rivaroxaban in triple-positive APS; reasonable alternative if DOAC contraindicated |
| aspirin | NOT RECOMMENDED for travel VTE prevention (documented as anti-recommendation only) | PO | n/a | Cochrane 2006/2016 + LONFLIT-3 + WRIGHT 2007 — no benefit for travel VTE prevention; possible bleed harm; explicitly listed as not-recommended in Watson + Baglin 2011 and ACCP 2021. Listed here as anti-recommendation; do NOT prescribe ASA for travel VTE prevention |
Plan: Travel-associated DVT — 3-mo provoked AC + structured future-travel prevention plan (ACCP 2021; Watson + Baglin 2011)
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
Stop AC at 3 mo with symptom + reassessment visit; structured future-travel prevention plan: stockings 15–30 mmHg + hydration + walking for everyone; LMWH single dose pre-flight if high-risk (prior VTE, active cancer, known thrombophilia + planned >4 h flight); reinforce that ASA is NOT recommended for travel VTE prevention (Cochrane / WRIGHT 2007)
Guideline: ACCP/CHEST 2021 (Stevens) + Watson + Baglin 2011 BCSH travel thrombosis + ASH 2020 VTE Treatment