Travelers' Thrombosis—A State of Practice in Germany

Abstract

Evidence-based guidelines to prevent travelers' thrombosis (TT) are still missing. We wanted to know whether travelers perceive the risk of TT, how they and their physicians cope with this in daily life, and whether recommended thrombosis prophylaxis (TP) was actually performed. A standardized questionnaire (Q1) asking for age, gender, travel habits, and the assessment of the risk of TT was given to randomly incoming travelers seeking for travel medicine advice prior to long haul travel. A second questionnaire (Q3) focusing on the actually performed TP was answered by these travelers after return. The physician assessed travelers' thrombosis risk (TR) and gave specific recommendations for TP in questionnaire Q2. Besides analysis of age, gender, the awareness of the risk of TT, travelers' TR, duration, and kind of travel, we compared performed and recommended TP and analyzed the influence of relevant factors on TP. A total of 315 travelers (43.3% male, aged 43.2 ± 15.9 y) took part in this survey. We received responses from 275, 309, and 248 travelers who answered Q1, Q2, and Q3, respectively. Travelers (91.6%) were aware of the risk of TT which was significantly higher among travelers aged 60 years and older. Travelers' TR had a significant influence on recommended and performed TP (p < 0.001). We found a moderate agreement between recommended and performed TP (kappa coefficient = 0.54). More travelers than recommended performed a specific TP (49.6% vs 39.8%) which was mainly done by the intake of acetylsalicylic acid (ASA). Travelers are well aware of the risk of TT and are compliant to perform at least the recommended TP for which physicians predominantly consider travelers' TR. The high rate of non-recommended intake of ASA and the different dosage regimes recommended for TP with ASA or heparin, however, indicate the need of better information for travelers and physicians.