Saturday, 19. of April 2014
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Travel in patients on anticoagulation

There is only rare, and no current, scientific data on travel habits or travel-associated incidence of bleeding or thrombo-embolic episodes”, pointed out Heinz Völler, MD, of Rüdersdorf, Germany, in his talk. “The major consequence for the patient should be intensified INR testing while traveling to identify relevant changes at an early stage, enabling the taking of adequate counteractive measures.”Changes in INR can be caused by drug-drug interactions, e.g. for tetracycline the bleeding risk is ninefold. “But patients should definitely not be discouraged from taking an adequate antibiotic and malaria prophylaxis or having the required vaccinations,” said Völler. Formerly, vaccinations in patients on treatment with VKAs were all given subcutaneously until it was recognized that adjuvants induced an unacceptable rate of local reactions and that the intramuscular route was possibly associated with a better immune response.Infectious diseases lead to a procoagulant or hypocoagulant status, and are associated with an increase in the activity of some clotting factors, especially fibrinogen and factor VIII. This means an increase of thrombophilic risk, although the INR may remain unaltered. Völler strongly suggests an optimal protection against infectious diseases such as hepatitis.In addition, changes in lifestyle can change the INR, including several exotic foods and increased consumption of alcohol. Climatic influences also play a role: High temperature increases the bleeding tendency due to vasodilatation. High altitude (>2500m) means a 2.7-fold increased risk for lower INR values.“If traveling by air, the self-testing device, all equipment and all drugs should be carried in the hand luggage” Völler advised those patients present. “X-ray at the airport does not harm the functioning of the device, and it’s important not to forget: a reliably working refrigerator is required at the destination.”

Report by Thomas Klein, MD, MSc (Nov. 2009)