GPAtlas🧭 When to offer advice
Travel-related venous thromboembolism (VTE) is a real but weak association. Long-distance travel modestly increases – roughly two- to threefold – what is already a low baseline risk: symptomatic VTE occurs in the order of 1 in 4,600 after a single flight of more than 4 hours. Risk rises with journey duration and, far more importantly, with the number of pre-existing risk factors the traveller carries. The great majority of cases are entirely preventable with simple advice.
"Long-distance travel" is conventionally any flight, train, or car journey lasting more than 4 hours. The task in primary care is to risk-stratify every such traveller and match the intensity of prevention to their risk – from general advice for all, through graduated compression stockings at moderate risk, to specialist-considered pharmacological prophylaxis for the small minority at very high risk.
| Risk category | Typical features | Recommended prevention |
|---|---|---|
| Low | No additional VTE risk factors | General measures only – hydration, mobility, calf exercises |
| Moderate | A single risk factor – e.g. obesity (BMI > 30), older age, pregnancy or postpartum, oestrogen therapy (combined hormonal contraception or HRT), recent minor surgery, extensive varicose veins, or significant comorbidity | General measures plus below-knee Class 1 (14–17 mmHg) graduated compression stockings / flight socks |
| High | Previous VTE (especially unprovoked or travel-related), known thrombophilia, active malignancy, major surgery within the past 4 weeks, or two or more risk factors | General measures and compression stockings; assess fitness to travel and consider LMWH (specialist-guided) |
Source: NICE · British Society for Haematology
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