Travelling on Warfarin


I was just wandering if any of you can share your experiences of travelling on long flights ie. 10 hours with APS (previous stroke) whilst on warfarin. I would like to travel to Hawaii from sydney with my family but am a little worried and unsure of whether I would also need Clexane shots. I am seeing my specialist at the end of the month but would like to hear of other people's experiences also.

Thank you

15 Replies

  • 10 Hours on a flight I believe would warrant a mid flight shot of Fragmin. Prof Hughes always tells me to do one. Im on Fragmin and Ive had a previous Stroke. You must take your consultants advise but I do think its warranted. Look on the HSF website too where there is also travel advice such as this.

  • Not sure whether I would need to inject as I am already on warfarin?? Are you on warfarin or asprin?

  • I take Warfarin and always inject with clexane (fragmin) on long haul flights. As per the instructions from my medical team.

  • My hematologist told me to make clexane shot on flight longer than 4 hours. And to get up and walk every hours

  • Warfarin and enoxaparin? You would need specialist advice from an APS medic.

  • Check with your consultant.

    When I asked Dr Cohen and a few other APS consultants and my warfarin nurses for 8hr flight to New York they all said that there was no need for heparin if you are stable and in range on warfarin.

    I had my INR checked the day before I flew out and the day after I got home.

    My INR increases on flying to 5. If I had the heparin as well I think I would be in more danger of bleeding out.

    Wear flight socks, move around regularly and get the extra legroom seats.

  • Similar to my experience

  • Yes, must check with your consultant as to what suits you rather than the rest of us.

    I would add to the advice about walking about in the aircraft, drink plenty of water and no alcohol.

    I am on warfarin, with Fragmin shots if under 3.0 (target 3-8 to 4.0) and I have had a stroke on a plane- 4 hrs flight a good few years ago when INR target was around 2.6.

  • A few years ago I flew to Australia and you cannot get a much longer flight then that.

    I just took my Warfarin as normal and did not have a problem. The only thing that I was told to do was to make sure that I had my INR checked in Australia.

    Everything was fine.

  • I just came back from a flight from New Jersey in the U.S. to Heathrow, London--6.5 hours going on 7/31 and 7.5 hours returning on August 13th. Once in London, was at sea on the Royal Princess for 13 days cruising the Channel Islands. I am on Warfarin, and also have had a history of DVT--hospitalized 15 years ago and on Heparin and Coumadin for several months--and 2 years ago 3 DVT at same time in three veins in my leg. I have APS, and also Factor V Leiden. While everyone was sleeping, I walked every 20 minutes throughout both flights.

    Five years ago, made the trip to Hawaii from New Jersey which was non/stop for 11 hours. Again, while everyone slept, I walked every 20 to 30 minutes throughout both flights. I was not on Warfarin at the time, and did not know that I had these 2 blood conditions until a year and a half ago when, after the history of DVT's I was diagnosed with the cause, but I have residual vascular and circulation damage in my leg from the DVT 15 years ago and did this as a precautionary measure.

    I self test for my INR and brought the machine with me on this London trip. Per my hematologist who treats me for the APS and Factor V, I did not have to inject with Lovenox as long as I was taking the Warfarin. But I'm sure your doctor will advise you how to handle it. My doctor wrote a note for me to take on the plane which stated that I have a very serious vascular/clotting condition, must ambulate, and need an aisle seat. British Airways accommodated me.

    When I was diagnosed with my two blood conditions, I made myself a promise that I was still going to enjoy my life and not let it stop me from travelling, or whatever else I enjoy doing. I hope you do the same and enjoy Hawaii if you decide to go.


  • Agree absolutely about taking a regular wander about the plane. I used to tell the stewards why I needed to move about and why- they tend to get a bit suspicious of possible intentions otherwise. I also do the exercises that are usually recommended in the inflight magazine, twiddling your feet around etc. The only time you might be cautious with the explanation you give is if you are in an emergency exit seat. I have had no end of battles with booking staff and crew who jump to conclusions abot fitness to handle the door in an emegency and ban you from emergency exit seats just because you want to take sensible steps to protect yourself from clotting opportunities. At 6'5" I need extra legroom and if I don't get it I won't fly so now I am less open with them and just book what seats suits.

    I imagine that there must be no end of people taking syringes into the cabin with them. I have for the last few years flights but have never been asked to show the letter that cost me £20 to get!

    Enjoy your trip.

  • Hi Cookie,

    I'm under the care of St Thomas' and had the same worries as you.

    I'd been considering taking a flight quite soon after I had recovered from massive bi-lateral PE's and was advised against flying at that time.

    Then once I was better and wanted to go on holiday I was told to check my INR on the morning of the flight and if I was in range (3-4) then fine. I was told that if my INR was below range to have a clexane injection and I'd be fine. In fact, I was told I'd be the safest person on the plane!

    Hope that helps?


  • Sorry - just one more thought!

    Whenever I travel I take my self checking machine and a few clexane syringes with me. If I can't get hold of the specialist nurse by e-mail to check the dose of acenocoumarol then I look back through my yellow books to see if I should change the dose or use clexane.

  • Hi Cookie - Yvonne Wren who works for the HSF is the guru on this - she's travelled all over (including Hawaii) and gave a talk at one of our Patients' Days about the best way to do things.

    Please contact her either on this forum: or at the charity address

  • Aloha Cookie. As Kate said, I travelled from London to Hawaii in 2009 and have travelled long trips a lot since (including 7 flights in 2 weeks!)

    The advice above is all excellent and you have to be advised by your consultant but I would add that I had concerns over crossing so many time zones and maybe over or under dosing myself with warfarin. I overcame this by having an extra digital watch which I kept on home time and set the alarm to ring at the usual time I take my warfarin. I self manage so checked my INR before and after long haul. I took pre-loaded clexane/lovenox syringes (with a consultant's letter for customs) but hadn't taken enough so found a lovely doctor in Kihei, Maui, who prescribed some more for the rest of the holiday. Make sure you have APS named on your insurance certificate and look up contact details for local hospitals before you go.

    Have a fantastic time. Hawaii is one of the most beautiful and interesting places in the world. Yvonne

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