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Deep vein thrombosis - prevention for travellers - Management
Basis for recommendation

Use of low-dose aspirin

  • The use of low-dose aspirin for prevention of travel-related deep vein thrombosis is controversial and unlicensed [BMA, 2004].
  • A single dose of aspirin (150 mg) before travel is recommended by the Scottish Intercollegiate Guidelines Network (SIGN), based on expert opinion [SIGN, 2002]. However, SIGN acknowledges that the balance of risk and benefit is difficult to estimate because the absolute risks of symptomatic venous thromboembolism with long distance travel, and the absolute risks of bleeding with single-dose aspirin, are undefined.
  • CKS does not recommend the use of low-dose aspirin because there is no evidence to support this. This is in line with current guidance issued by the Department of Health, World Health Organization, British Medical Association, British Committee for Standards in Haematology, and the American College of Chest Physicians [BMA, 2004; British Committee for Standards in Haematology, 2005; DH, 2007; Geerts et al, 2008; WHO, 2008].

For people already prescribed aspirin for cardiovascular protection

  • The Department of Health does not recommend increasing the current dose of aspirin [DH, 2007].
  • CKS found no guidance on managing low-dose aspirin therapy for these people if low molecular weight heparin (LMWH) is indicated. Feedback from CKS expert reviewers generally indicated that aspirin for cardiovascular protection should be continued, taking into account the increased risk of bleeding. Consequently, CKS advises seeking specialist advice when LMWH is indicated for people prescribed aspirin for cardiovascular protection.

For people undertaking high altitude activities

  • Because of the lack of evidence and guidance, CKS does not recommend the use of aspirin before the return flight for people who have undertaken high altitude activities. This is supported by feedback from CKS expert reviewers.

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