The American College of Chest Physicians has introduced new guidelines for preventing and treating thrombosis and now offers specific recommendations for long-distance travelers.
Antithrombotic and thrombolytic therapies are used to prevent thrombosis or blood clotting in the arteries, veins, or heart. Thrombosis can ultimately lead to a potentially fatal blockage in the lung, or venous thromboembolism (VTE).
The last version of the guidelines was published in 2001. Approximately 230 recommendations have been added.
An anticoagulant, fondaparinux (Arix-tra®, Sanofi-Synthelabo), is recommended as an alternative to the standard anticoagulant, low-molecular-weight hep-arin (LMWH).
To avoid “economy class syndrome,” travelers should be informed as follows:
• For flights longer than six hours, patients with or without risk factors for VTE should avoid dehydration and constrictive clothing around the lower extremities and waist and should frequently stretch the calf muscles.
• Patients at risk for VTE should consider using graduated compression stockings or taking LMWH or fonda-parinux before departure.
• Aspirin is not recommended for preventing VTE associated with travel.
For coronary intervention, the revised recommendations now advise against using the platelet inhibitor ticlopidine (Ticlid®, Roche), if other treatments are available, because of its adverse effects.
For most patients with unstable angina or a minor heart attack, clopidogrel bi-sulfate (Generic Plavix®, Bristol-Myers Squibb/ Sanofi), in combination with aspirin, is recommended.
For patients with non-heart-related stroke, tissue-plasminogen activator should be used only within three hours of stroke onset.
Guidelines recommended against the sole use of aspirin to prevent thrombosis for all patient groups.