History of obstetric APS: Heparin not required anymore for long-distance air travel?

[Candyland]

Hello,

I just very recently discovered this site & what a wonderful resource it is. I've already learned a lot of new information so quickly. I'm wondering if someone might be able to help me think this through.

I am travelling soon from Vancouver, BC, Canada to Auckland, New Zealand (14 hours flight @ an altitude of about 9,000-12,000m) & 1 week later carrying on to Fiji (3+ hours flight), then doing it all again in reverse 16 days later for the return home. All flights will be on Boeing 777-200's & 300's. (I saw the post from APsnotFab about the 777's!)

My question is: Should I be using Heparin during my travels?

A bit of my health history: recurrent early miscarriages & migraines 17 years ago, diagnosed with APS (type: anticardiolipin antibodies), Rx heparin during & after pregnancy, low dose ASA daily since, & heparin as needed (ie. surgeries & flights that are >5hours). Fortunately I haven't had an embolism or thrombosis.

I went to see my regular family doctor to request the heparin Rx but he's away for a couple of months so I had to see the attending physician, who wasn't familiar with my health history. I mentioned all of the above as well as 2014 being the last time I used heparin (hysterectomy). He mentioned that I might be able to avoid heparin injections because there are direct oral anticoagulants available now. After he consulted over the phone with an internist & a hematologist at a local hospital the verdict a couple of days later was that people with APS don't need anticoagulants anymore for long-haul flights because protocol had changed in the last 5 years. He said to just walk around every hour (no sleeping on a 14 hour flight?), take my daily aspirin & to "just enjoy the vacation". I'm a bit concerned with this as it's such a big change from what I've always known & there are so many flights involved in a 3+ week span. I also read somewhere in my "travelling with APS" research that Fiji is a beautiful destination but that their hospitals are a bit 3rd world & to avoid if possible. So I could be risking a possible thrombosis in a destination with less than ideal care & conditions, making a bad situation even worse.

The 'diagnosis' seemed casual or general as the internist & hematologist never talked to me, to even consider me as an individual patient & what particular risks I may potentially have. The attending physician seems to just want to go along with what they say & nobody even suggested compression stockings, staying well hydrated & avoiding alcohol. I'm thinking of returning to the doctor's office to insist on the heparin. Any thoughts?

And has anyone come across the information regarding the changes in protocol for long-distance air travel for those with APS?

[silemoran]

I have never heard of that sorry ,hope your journey is safe .

[Candyland in reply to silemoran]

Thank you for the good wishes silemoran, I plan to do as much as possible on my end to stay safe & healthy. This is my family's one big trip of a lifetime.

[Fra22-57]

Ifo t know about change in protocol but I asked about heparin for longer flights and was told not necessary.I am on warfarin.I dont know if its cos not had an event and just neurological and movement disorder

[Candyland in reply to Fra22-57]

Hello Fra22-57,

If I'm correctly interpreting what I've read so far, you are set to go for longer flights if you're already on warfarin. I've heard it said that "you're the safest of anyone on the airplane". (?)

[Wittycjt]

I would definitely question that with your regular APS doc, not a fill in one

[Candyland in reply to Wittycjt]

Hi Wittycjt, yes I've been trying but so far no luck. Very frustrating!

[MaryF Administrator]

I have been told that if I go long haul, I need to inject Heparin or Fragmin, I am not on Warfarin, and have not had a clot for many years. I would seek advice of a recommended Hughes Syndrome/APS specialist with working knowledge not somebody with only half the information to hand. MaryF

[Candyland in reply to MaryF]

The protocol you mention MaryF is what I too have always been told. I also am not on Warfarin, my main complications were the early miscarriages. After reading other people's stories & posts it gave me the courage & knowledge to return to the doctor's office to insist on the Heparin Rx, but after much discussion I still left empty handed. Grrr! He wanted to see if he could try & get hold of my Dr. first & would call me back. So far I haven't heard anything. Double Grrr! I'll follow-up in the morning.

[Stereolover]

Candyland do you not take any anticoagulants in tablet form? It’s a long flight but if you’re on medication it should hopefully be enough. I’m not a doctor though, far from it. However if I was flying for that length of time I would definitely wear surgical socks/stockings for a little peace of mind.

[Candyland in reply to Stereolover]

Hello Stereolover, I don't take Warfarin or any anticoagulants at all. I agree with you, if I did then I should probably be fine. To help myself as much as possible I'll do the recommended non-pharmacological methods, such as compression stockings (I was thinking of a pressure of 20-30mmHg?), hydrating well at least 48 hours before, during & after flight, walking around hourly, various exercises, limit alcohol & caffeine, no sleeping tablets & a brisk walk right after the flight. Also, my usual low-dose Aspirin. Although the literature doesn't show it to be very effective at preventing clots in veins at least it will help to prevent clots in my arteries. If anyone has any other tips I'm definitely open to them.