Travel and venous thrombosis: a systematic review


S. Middeldorp, MD PhD internist, Department of Clinical Epidemiology, C9-P, Leiden University Medical Center, PO Box 9600, 3500 RC Leiden, the Netherlands.
(fax: +31 71 5266994; e-mail:


Abstract.  Kuipers S, Schreijer AJM, Cannegieter SC, Büller HR, Rosendaal FR, Middeldorp S (Leiden University Medical Center, Leiden; and Academic Medical Center, Amsterdam; and Leiden University Medical Center, Leiden, the Netherlands). Travel and venous thrombosis: a systematic review (Review). J Intern Med 2007; 262: 615–634.

In the past decade, numerous publications on the association between venous thrombosis (VT) and travel have been published. Relative and absolute risks of VT after travel, and particularly after travel by air, have been studied in case–control and observational follow-up studies, whereas the effect of prophylaxis has been studied through intervention trials of asymptomatic clots. The mechanism responsible for the association between travel and VT was addressed in pathophysiologic studies. Here, we systematically reviewed the epidemiologic and pathophysiologic studies about the association between travel and VT.

We conclude that long-distance travel increases the risk of VT approximately two to fourfold. The absolute risk of a symptomatic event within 4 weeks of flights longer than 4 h is 1/4600 flights. The risk of severe pulmonary embolism (PE) occurring immediately after air travel increases with duration of travel, up to 4.8 per million in flights longer than 12 h. The mechanism responsible for the increased risk of VT after (air) travel has insufficiently been studied to draw solid conclusions, but one controlled-study showed evidence for an additional mechanism to immobilization that could lead to coagulation activation after air travel.