Blood Clots

Whenever I think of it each year I try to post some travel advise concerning Blood Clots. Here is my experience. I had traveled to Europe 3 times before and was aware of the possiblity of getting a blood clot. On flights over and back I would walk around the plane and do knee bends. I also would try to get an aisle seat so I could on occasion straightedn my legs. In short, what would appear to be all the right things. After returning from Italy and back at work, I got a small sharp pain under my arm on the rib cage. Which i of course I did nothing for. A day later it was now hurting in my neck, so went to doctor. Short story is I ended up in the hospital for 4 days with 7 blood clots in my lungs. 4 and 3. Doctor said I was lucky. I have since returned to Europe with no ill effects. However, I now take certain precautions. I am NOT a physician. I suggest you have a brief chat with your doctor about this. What I now do is.. I start taking a full aspririn morning and night 2 weeks before. Then 4 days before the flight I take 1 in the morning and continue them while in Europe. I also wear a pair of compress socks while in the air. When this happened I was 55. As I understand, being younger does not eliminate you from this danger. Can happpen to anyone. I do not intend to frighten anyone, just letting you know MY experience.

Posted by Ken
Vernon, Canada
17789 posts

Den, Thanks for posting that. It's a good reminder and something I should think about prior to my next trip. Did your Doctor recommend using Aspirin?

Posted by Rebecca
Nashville, TN, USA
645 posts

Did your doctor recommended this? (If you are doing it on your own, read the Wikipedia article online entitled 'aspirin poisoning".)

Posted by Den
Madison, Wi, USA
62 posts

Should of been clearer. Yes. My doctor recommended the aspirin. It helps thin the blood.

Posted by Laura
Virginia, USA
2900 posts

Rebecca, I was curious about the wiki article you mentioned. I'm interpreting it correctly, it seems to take quite a lot of aspirin for a toxic dose. The acutely toxic dose of aspirin is generally considered greater than 150 mg per kg of body mass. Chronic toxicity may occur following doses of 100 mg/kg per day for two or more days. That means a 150 lb person (68 kg) would need to take 6800 mg a day for two days for chronic toxicity. A single aspirin is 325 mg. That is the equivalent of 20 aspirins per day. Den is taking 2 aspirins a day. Den, thanks for the warning and sharing your experience.

Posted by pat
victoria, Canada
7828 posts

Den good post,, and yes aspirin is a commonly recommended preventative for those with possible clotting issues, of course one should consult doctor, before starting any drugs, but here in Canada anyways you can buy Aspirin in a 80 mg dose meant just for this exact purpose. And age has less to do with blood clots then people may like to imagine. Although not from flight, my own then 16 yr old daughter got a blood clot in her arm last summer.. out of the blue,, arm just started swelling up ( blood could not "return") .. it happened at work in middle of the day.. never assume something strange happening to your body is "nothing" if your instinct says something is wrong , go in!

Posted by Den
Madison, Wi, USA
62 posts

Remember me saying I am not a doctor? I had no clue what the full impact of a blood clots is. In the hospital, no one really sat down and explained things to me, guess they assumed I knew. Or that sommeone else had talked to me. After being in the hospital 2 days, I asked the question,, "What if these things break lose and get into my heart?" The nurse looked at me and said, "They already been there, that is how they got to your lungs." I then realized how serious this could of been. As the doctor said, I was lucky. The whole reason I put this out there is to simply make people aware. It CAN happen. I merely suggest before going on a long flight, talk to a physician for advise.

Posted by Rebecca
Nashville, TN, USA
645 posts

Thank you, Den. I am really glad you did bring this up. So sorry this happened to you.

Posted by Emily
Chicago
256 posts

Yes, Bets and I did discuss this. I was extremely fortunate to not get any blood clots after I broke my ankle in Europe-they supplied me with a few days of Lovenox and told me to drink lots of water. Did I mention I'm on birth control too? Like a ticking time bomb. I was sure I would need another dose when I got home, but my doctor told me just aspirin would be fine.
If you are worried about blood clots, please, please see your doctor before you start any type of med, even aspirin. Aspirin (and ibuprofen) have the potential to rip holes in your GI tract, causing possibly fatal bleeding. And Michael, you are mostly correct about those under 50 having a smaller risk of clotting. Blood clots depend on many factors, including smoking, birth control, dehydration, and certain genetic markers. The clotting cascade is very complex and the best thing to do is ask you doctor if you need extra support!

Posted by Tom
Hüttenfeld, Hessen, Germany
9133 posts

"And age has less to do with blood clots then people may like to imagine." No, actually age, with all the associated defects that accrue, is a major factor in the development of blood clots. That doesn't mean that younger people can't get them, but they are MUCH, MUCH less common than in the elderly. Bottom line- talk to your doctor. Everything, including taking aspirin, involves a balance of risk and benefit (although it's low risk for most people).

Posted by Michael
Des Moines, IA
2155 posts

I know aspirin can be used as a blood thinner and, therefore, may serve to help mitigate the effects of a heart attack, especially in folks that may have other risk factors such that they are on an aspirin regimen anyway, but I didn't realize it could be used to help prevent blood clots in healthy people taking long haul flights. That doesn't sound right to me, but I'm certainly not a medical doctor. Would a healthy person under the age of, say, 50 really need to consult a doctor about the possibility of blood clots prior to taking a long haul flight? The risk can't be too significant for most people (I wouldn't think).

Posted by Tom
Hüttenfeld, Hessen, Germany
9133 posts

"Would a healthy person under the age of, say, 50 really need to consult a doctor about the possibility of blood clots prior to taking a long haul flight? The risk can't be too significant for most people (I wouldn't think)." Without any risk factors (diabetes, poor circulation, heart failure, cancer, liver disease, recent surgery, strong family history, obesity, prior abnormal clotting, etc.) probably not. Some people may have one of several genetic defects that can increase the risk of clotting, but unfortunately, they would never know until it happens with no other obvious explanation (Dan Quayle has one such condition). Because none of these conditions are very common, I doubt health insurance would pay for the testing, unless there was some reasonable clinical suspicion.

Posted by Rebecca
Nashville, TN, USA
645 posts

Hi Laura, Yes, I posted that before he made it clear that he was doing that per his doctor's orders, not on his own, as his own idea. Thanks for your input. I just wanted everyone who came here and read his initial post to be aware that there is some amount of caution needed when taking aspirin and all over-the-counter drugs, because many people take such drugs freely, thinking that since they are not prescription drugs, no harm can come of it.

Posted by Bets
Bloomington
1970 posts

Thanks Den. Great reminder. My husband is on an aspirin regime and I start aspirin before long-haul flights. After what happened to Pat's daughter last summer, I need no more proof of age. BTW, I know several people who've died of clots, two this past year after broken bones. Emily, a nurse who posts on the Helpline, and I had PMs about this subject after questions about broken bones came up. She's wary of clots too.

Posted by Swan
Napa, CA
2858 posts

After reading some of these postings about blood clots and aspirin I decided to take baby aspiring (81 mg) daily before, during, and for a couple of days after my upcoming long flight. It's a simple enough preventative and that amount of aspirin should have no down-side AFAIK.

Posted by Ken
Vernon, Canada
17789 posts

"Blood clots depend on many factors, including smoking, birth control, dehydration" I've never asked, but I suspect dehydration is the reason that Flight Attendants are constantly offering bottled water during long flights. I always accept it when offered, but I also carry my own 500 mL bottle (purchased after security of course).

Posted by Tom
Hüttenfeld, Hessen, Germany
9133 posts

I forgot one major risk factor that can affect relatively healthy young women... the combination of birth control pills and smoking. By themselves, neither is enough to raise the risk over that of the general population of under 40 year old women, but together, they raise the risk about fivefold.

Posted by Ellen
Centennial, CO, USA
1396 posts

I get terrible swelling in my ankles now on trans Atlantic flights. After ready Den's post, I think I'll try the aspirin program before our fight in 2 weeks. I really suffered last trip, I could feel my ankles/feet start to swell, even though I moved during the flight, got up and walked around, put my feet up above my head (yep, I'm limber) and moved my feet in circles and flexed and pointed my toes. It was painful to say the least. This just started to happen to me the last few years and makes travel that much harder. I plan to call my doctor to see if she might have any other suggestions, but the blood thinner idea makes sense to me.

Posted by Sherry
San Jose, CA
1139 posts

For those who decide to self medicate with aspirin, I'd like to reiterate that the clotting cascade is very complex (and understanding of it continues to evolve). So it would be good to talk to your doctor about your plan, as well as the timing. (Might as well make sure the timing of dosing makes physiological sense.) I've almost died twice of clot-related problems... have three of genetic risk factors. Anticoagulation is not something you want to deal with casually. And if you're really worried (or troubled by swelling), the medical grade compression stockings are a good precaution. I always wear them when I fly. But they need to be fitted carefully by a professional (after your dr has prescribed the right level of compression). If fitted wrong or put on wrong, you can interfere with circulation.

Posted by Michael
Des Moines, IA
2155 posts

What about those with Low T? I'm asking for a friend, not for me, of course! While I'm on that subject, what about those with ED? Again, it's for the same friend, not me. Any blood clot issues my friend should be concerned about? Maybe the fish oils can help him, too.

Posted by Jim
Dallas, Texas, USA
495 posts

While we are on the topic regarding health on flights; although somewhat geeky, we've started wearing surgical masks on last two flights. Does it help/work? Or is it psychological? After 2 flights, one to Europe and one to United Emirates we became quite ill, although I'm a reformed ex-smoker, my wife became ill as well. Our last two lengthly trips have been illness free. I also realize that even when wearing a mask, you have to occasionally take them off when drinking water, etc. Was my illness a coincidence or has anyone else experienced this?

Posted by pat
victoria, Canada
7828 posts

Just want to add, my daughter doesn't smoke or use birth control.. ( have to clarify that as a mom, lol ) she also has no genetic markers , trust me all the tests were done after to confirm that. She has something called "Thoracic Outflow Syndrome" and apparently its not that rare.. her only previous symptoms ( which we unfortunately dismissed) was occasionally waking up with tingling in her hands,, we told her she was likely sleeping on her hand /arm and it just fell asleep.. Thoracic Outflow syndrome is something many people live with without even being fully aware of having , causing no problems other then some vague symptons that people often assume are "just aging".. ie: when doing your hair ladies and you are holding your arms up blowdrying or curling, do they feel tired quickly? The complications from TOS often come with age, as our circulation gets worse,, blood clots more likely to form. They have found that those with TOS often have a top rib that is just placed higher then most people. The solution for my dd was to remove that rib. She had the surgery done in December and has recovered nicely. They however do not do the surgery in anticipation , so her left arm has not been done although rib is just as high there.. we have been told what to watch for now ( we had no idea when her arm started swelling suddenly, now we know off to the hospital) In my daughters case they actually think that because she had been in a rowing program at school( so nothing super intense) and built up her shoulder muscles it caused increased constriction on the vein. She had a habit of sleeping with her arm raised over her head, viola , the perfect set of circumstances.

Posted by Wendy
Prince George, BC, Canada
2 posts

I was worried about blood clots as well, as they are a possible complication of the hormone replacement therapy I'm taking for menopause symptoms. I'm flying to Europe in June and my naturopath recommended taking an Omega 3 fish oil supplement instead of aspirin to prevent blood clots. Has anyone else received that advice?

Posted by Ms. Jo
Frankfurt, Germany
4768 posts

My Dr. gives me a prescription for thrombosis shots. I get 2 of them, one for the trip there, one for the trip back. They last about 12 hours, and security doesn't seem to care much, as long as you tell them you have them in your carry-on. Quick stop in the restroom, shortly before the flight, easy shot, as it is subcutaneous, and all is good to go. It allows me to rest easy on my flight. I know this isn't something everyone can do, but it sure makes flying less of a worry for those of us who have vein problems and are in danger of blood clots.

Posted by Tom
Hüttenfeld, Hessen, Germany
9133 posts

"While we are on the topic regarding health on flights; although somewhat geeky, we've started wearing surgical masks on last two flights. Does it help/work?" Unless you're wearing a properly fitted M95 respirator, which would be extremely uncomfortable to wear for the duration of a transatlantic flight, no. Surgical masks protect the patient from pathogens, but not the wearer (although of course, they protect the surgeon from spurting bodily fluids). Now, if you're already ill when flying, wearing a mask may protect some of your fellow passengers. To answer another question... fish oil and omega 3s have some benefit in reducing certain types of cholesterol, but they have absolutely no effect on coagulation. And while we're on the subject of apsirin... a key distinction between aspirin and prescription anticoagulants is that aspirin has little effect on the clotting cascade. It has most of it's effect by binding to platelets and preventing them from sticking together. Why is this important? Because the binding is irreversible. If you're taking apsirin at sufficient strength and duration to prevent clotting on a flight, the effect will likely last for 2-3 weeks afterwards, until your body turns over its supply of platelets. The flip side of making it harder to form clots is that it also makes it harder to stop bleeding. God forbid that you were involved in some kind of accident, you could lose a significant amount of blood before the doctors treating you realize why they can't stop your internal bleeding. So, like every medical intervention, there's risks and benefits. Bottom line- discuss it with your doctor if you have concerns.

Posted by pat
victoria, Canada
7828 posts

What Tom says is true about taking a blood thinner of any type, if taking a prescription one , you should probably wear a medical alert id, there are drugs they can give you to help with bleeding in an emergency but as he notes, how long will it take them to notice you have an issue because of blood thinner. We had my dd wear an id, as we worried is she was hurt in a car accident etc, was unable to speak, but did not appear to be outwardly bleeding that she could be bleeding out internally . If you are taking over the counter blood thinner that might put you at a bit more risk then since you likely wouldn't think to wear an id. Now, I don't know for sure, but maybe taking aspirin isn't as bad as say something like Coumadin where they purposefully keep your clotting factor low?

Posted by Tom
Hüttenfeld, Hessen, Germany
9133 posts

"If you are taking over the counter blood thinner that might put you at a bit more risk then since you likely wouldn't think to wear an id. Now, I don't know for sure, but maybe taking aspirin isn't as bad as say something like Coumadin where they purposefully keep your clotting factor low?" Technically, there are no "over the counter" blood thinners, because aspirin is an anti-platelet agent, not a blood thinner. But that's mostly just semantics. The risk of bleeding on a therapeutic dose of coumadin certainly is higher than aspirin. But excessive bleeding due to coumadin is easier to regognize. A simple, universally available blood test will reveal the cause, and the treatment is plain old vitamin K. Bleeding due to aspirin? Harder to recognize, because the common clotting tests will be normal. And the treatment is a platelet transfusion, which is rather more complex. This may be a problem if a traveler finds themselves hemorrhaging in foreign hospital with a language barrier.