Hello doctor, Last month I was diagnosed with DVT in my left calf, one perineal vein has occlusive thrombus 10 cm below the knee extending 19 cm below knee, also mild occlusive thrombus of posterior tibial vein 10 cm below knee and extending to 12 cm below knee. I was immediately taken off my birth control, Levlen ED which I have been on for 17 years, this is what the doctors believe is the cause, I was placed on Eliquis (Apaxaban) medication, for one week (7 days). I was taking a double dose (10 mg in the morning and 10 mg at night) and then 5 mg in the morning and 5 mg at night (to continue for three months), a blood test was conducted with normal results in blood, liver and kidney, but showing an increase in white blood cells. The doctor said should be due to having the clots. The questions I have (which I have also spoken to 2 doctors) is around travel, three weeks after diagnosis, I have travel plans, both doctors said I should be fine to travel on a plane as I am already taking the blood thinner medication, wearing compression socks (15 to 20 mmhg) as long as I ensure I am standing and walking around the plane, I would like some advice. How does high altitude affect DVT? And is it fine to do this hike or is high altitude and exercise a risk? Is my risk of PE very low? Both doctors have told me I can go on this trip, but I am wondering if I should change my plans around these remote areas. I am not sure of what percentage of my type of DVT turns into a PE. Will my 2 cm or 9 cm clot be dissolved if I started medication a month before? Is there any other precautions I should be taking?
Hi. I have read your query thoroughly and checked your attached ultrasound as well (attachment removed to protect patient identity). Below is the answers of your questions as per my opinions. 1. You can travel by aeroplane for visiting any place. You have to take care in wearing compression socks and you have to take medication regularly. 2. It has always been controversial opinion whether high altitude carries risk for thrombosis or not. Let me tell you that in books high altitude are not written as main causative factors for thrombosis. But as per my knowledge high altitude can lead to physiological changes in blood and red blood cells count and hemoglobin can be increased, so indirectly it carries little risk of thrombosis formation. 3. So if I would be your treating doctor than I would not suggest you not to travel to high altitude because we cannot take even less than 1% risk also. So as per my opinion until three months of completion of therapy do not go to such a remote high altitude area where you cannot get medical access. 4. You are right. Clot will mostly dissolves in one month as you have been given best medication for that. But minor clot can remain and it might take more than one month to dissolve completely. Your high leukocyte count could be due to clot. So finally although risk of pulmonary embolism is very low, I would not suggest you to go at high altitude where medical facility is not available. It depends on you to take the final decision.