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Immobilization and VTE: Are Long Trips Really Dangerous?

Travel for more than 8 hours did not significantly increase the risk for venous thromboembolism.

Immobilization is a known risk factor for development of venous thromboembolism (VTE), yet the relative effects of different types and durations of immobility are not known. In a prospective noninterventional study, researchers determined the correlation between type of immobility and risk for VTE in 7940 patients who self-presented to 12 emergency departments and were being evaluated for VTE. Categories of immobility were none, generalized (whole-body immobility for >48 hours), limb, travel (immobility for >8 hours because of travel within the previous 7 days), neurological (paralysis), and other.

Overall, 1394 patients (18%) reported immobility, and 545 patients (7%) were diagnosed with VTE (pulmonary embolism in 354, deep venous thrombosis in 72, and PE and DVT in 119). Risk for VTE varied by type of immobility as follows: limb (odds ratio, 2.25), neurological (OR, 2.23), other (OR, 1.97), generalized (OR, 1.76), and travel (OR, 1.19). The increase in risk associated with travel was not statistically significant.

Comment: In this study, risk for VTE varied by type of immobilization and did not increase significantly from travel. Of note, the type of travel (airplane, train, or automobile) was not recorded and might prove significant. Until further study differentiates the risk for VTE associated with different types of travel, consideration of travel history in the work-up of VTE should not change.

— Richard D. Zane, MD, FAAEM

Published in Journal Watch Emergency Medicine September 11, 2009

Citation(s):

Beam DM et al. Risk of thromboembolism varies, depending on category of immobility in outpatients. Ann Emerg Med 2009 Aug; 54:147.

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• Factor Five Leiden
  Mark Osborn, 25 Sep 2009 2:54 PM EST
  My brother died at age 37 from a PE. I inherited the Factor Five Leiden mutation. I have had several... [more]
• FACTOR FIVE LEIDEN
  Tony K Munson, 9 Nov 2009 3:07 PM EST
  I couldn't agree more with Mark Osborn's comments. I, too, have the Factor Five Leiden mutation and have now had... [more]