There is an increasing opportunity for the pharmacist to supplement, or in many instances replace, the GP in providing medical services. Many pharmacists are already offering screening for blood pressure and diabetes and can provide useful information for some medical conditions.
There is a clear role for more and more pharmacists to offer advice to travellers. All people intending to travel should ask themselves the question, ‘am I fit to fly?’. If the answer is no, or there is a degree of uncertainty, they should seek advice. The pharmacist is in an ideal position to offer this advice. The purpose of this article is to consider one aspect of advice the pharmacist may give with regard to travel thrombosis.
Travel thrombosis is now a recognised condition. It can affect all travellers, whether it be by air, sea or road, and seems to be related to long periods of immobility. There is little evidence to suggest that flying is any more dangerous than taking a long sea voyage or traveling by train, bus or car. A pharmacist can assess the risk of travel thrombosis. These risks clearly relate to increasing age of patients, a past history of deep vein thrombosis of whatever cause, a co-existing medical illness, recent surgery, recent accident and, in particular, immobilisation in a plaster cast.
Any traveller with any of these conditions is clearly at increased risk. Pharmacists can identify those patients who are at no additional risk, those with some risk factors and those with considerable risk factors. The pharmacist is then in a position to provide advice. This advice can be offered to all travellers, including supplementary advice to those travellers with increasing risk factors.
All passengers should be aware that sitting down for long periods of time results in the stagnation of blood flow through the legs, which may precipitate thrombus formation. Clots usually start in the small veins in the leg and progress into the larger veins. The process might start during travel and can then continue, often during the holiday period, with further extension occurring during the return journey. For this reason, travellers are more likely to experience problems on the return journey.
Travel health advice
Before traveling passengers should be encouraged to exercise (walking). After sitting for long periods further exercise can be taken, which may involve walking or carrying out active exercises while seated. The avoidance of drinking too much alcohol combined with drinking plenty of water is also advisable. All patients can be advised to wear graduated compression socks (class II). These must be fitted, which means the patient must be measured to provide effective calf compression. Not only do graduated compression stockings promote the flow of blood through deep veins, but they also prevent venous distension, which has been shown to cause gaps in the endothelium making the lining more prothrombotic.
The use of anti-platelet agents can be considered. In patients of moderate to increased risk active foot exercising devices and low molecular weight heparin can be recommended or prescribed.
In 50 per cent of cases deep vein thromboses occur without causing any symptoms. Sadly, the first symptom could be acute shortness of breath or even death following a pulmonary embolism. All travellers should be warned that, although deep vein thrombosis remains a relatively infrequent occurrence, anybody developing a swollen leg following recent travel should undergo a duplex ultrasound scan. Early diagnosis and treatment may prevent a serious pulmonary embolism.
Independent pharmacists are therefore in an excellent position to offer advice, assess the risk and recommend prophylactic measures, which include graduated compression stockings, active foot exercising devices and medication ranging from natural anti-platelet agents through to anticoagulants.
Dr John Scurr
Consultant vascular surgeon
About the author
John Scurr is a world-leading consultant surgeon for vascular and general surgery, with a specific interest in venous disorders, including deep vein thrombosis and pulmonary embolism. Mr. Scurr was a consultant vascular surgeon at University College and Middlesex Hospital School of Medicine, a senior lecturer in surgery at the University of London, and head of the Department of Vascular Research. He is widely published in medical periodicals and textbooks and is a frequent presenter at international conferences. He is regularly called upon by the world’s media for his expertise, and has participated in a number of UK and EU government medical bodies and think tanks. John Scurr’s practice is primarily based at the Lister Hospital in London. For more information visit www.jscurr.com.