Anticoagulant Risk-Benefit Analysis for Traveling Afib Patients
DECEMBER 07, 2015
Jeannette Y. Wick, RPh, MBA, FASCP
With the increase in the number of patients diagnosed with atrial fibrillation or needing stroke prevention treatment, roughly 3 million Americans currently take warfarin, while a lesser number takes direct oral agents.
Different blood thinners pose various problems while traveling, so pre-travel office visits are recommended for patients on blood thinners to ensure that a risk-benefit analysis has been discussed.
“Economy class syndrome” is a clever term some use to describe thrombosis during or after flight. Air travel puts patients at a 2- to 3-fold greater risk for thrombosis, especially on flights that are 6 hours or longer.
The question of anticoagulation while traveling is discussed in an article published ahead-of-print in High Altitude Medicine and Biology.
The study author provided 5 questions practitioners should ask at pre-travel visits for anticoagulated patients:
· Why is the patient on anticoagulation?
· Does the patient need to stay on it?
· What are the choices for anticoagulation?
· Will there be any drug interactions with medication needed for travel?
· How will patients monitor their anticoagulation while traveling?
Despite 70 years of clinical use, warfarin—a vitamin K antagonist—presents many hurdles, especially for patients who travel.
In addition, traveling can by necessity or choice drastically change patients’ diets. What traveler doesn’t want to try local specialties? However, diet could greatly affect patients’ warfarin levels.
Monitoring also becomes a problem, especially if patients travel overseas.
The newer oral anticoagulants—dabigatran, rivaroxaban, apixaban, and edoxaban—directly inhibit coagulation factors with fixed dosing and no monitoring. With minimal adverse effects, few drug interactions, and no known dietary restrictions, these agents are ideal for many travelers.
Studies have also shown that altitude can cause warfarin international normalized ratio levels to be subtheraputic, putting patients at greater risk for clots. The lack of mobility and dehydration that accompanies air travel also puts patient at risk.
Asking these questions and considering each patient’s risks and benefits helps ensure the best outcomes and travel experience for the anticoagulated traveler.