Deep vein thrombosis and air travel: record linkage study

doi:10.1136/bmj.327.7423.1072

BMJ 2003;327:1072 (8 November), doi:10.1136/bmj.327.7423.1072

Paper

Deep vein thrombosis and air travel: record linkage study

C W Kelman, medical adviser¹, M A Kortt, assistant director¹, N G Becker, professor of biostatistics², Z Li, postdoctoral fellow², J D Mathews, deputy chief medical officer¹, C S Guest, visiting fellow², C D J Holman, chair in public health³

¹ Commonwealth Department of Health and Ageing, GPO Box 9848, Canberra, ACT 2601, Australia, ² National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT 0200, ³ School of Population Health, University of Western Australia, Perth, WA 6009, Australia

Correspondence to: C W Kelman christopher.kelman{at}health.gov.au

Objective To investigate the time relations between long haulair travel and venous thromboembolism.

Design Record linkage study using the case crossover approach.

Setting Western Australia.

Participants 5408 patients admitted to hospital with venousthromboembolism and matched with data for arrivals of internationalflights during 1981-99.

Results The risk of venous thromboembolism is increased foronly two weeks after a long haul flight; 46 Australian citizensand 200 non-Australian citizens had an episode of venous thromboembolismduring this so called hazard period. The relative risk duringthis period for Australian citizens was 4.17 (95% confidenceinterval, 2.94 to 5.40), with 76% of cases (n = 35) attributableto the preceding flight. A "healthy traveller" effect was observed,particularly for Australian citizens.

Conclusions The annual risk of venous thromboembolism is increasedby 12% if one long haul flight is taken yearly. The averagerisk of death from flight related venous thromboembolism issmall compared with that from motor vehicle crashes and injuriesat work. The individual risk of death from flight related venousthromboembolism for people with certain pre-existing medicalconditions is, however, likely to be greater than the averagerisk of 1 per 2 million for passengers arriving from a flight.Airlines and health authorities should continue to advise passengerson how to minimise risk.

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Rapid Responses:

Read all Rapid Responses

Exaggerated incidence of thromboembolism - ? misprint: Mo M Mansour
bmj.com, 7 Nov 2003 [Full text]
What is a long haul flight?: Andrew Brooke
bmj.com, 9 Nov 2003 [Full text]
Sex ratio not given: Ellen Grant
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ADVICE TO PATIENTS: STOCKINGS, ASPIRIN OR LOW MOLECULAR WEIGHT HEPARIN?: Y. C. Chan
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"What is already known on this topic" is incorrectly stated: Dr Y Adi
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Interpretation of case-crossover findings: Johanna G. van der Bom
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Underascertainment of pulmonary embolism deaths: Derek FH Pheby, et al.
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