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My Dr will not prescribe heparin for long haul flight

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I was diagnosed with Protein S Defficiency 4 years ago, after my mother tested positive after her 3rd blood clot.

I'm a healthy 28yr old man and my level is 60, just below the normal range.

I'm off travelling in Jan 2010 for 6 months, which will include several long haul flights between 10 - 18hrs.

I visited my Dr yesterday who contacted a Haemologist for advice regarding flying with protein S. To my surprise, the heamotologist said that there is no need for heparin or asprin and advised flight socks, water etc. Although my Protein S level is 60, I am worried about my family history. My mother has had several serious blood clots and my grandfather died of a stroke.

What would others advise, should I seek a second opinion or was the haemologist right to deny heparin and advise against asprin?


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Welcome to the forums!

If you haven't clotted before you should be 99.99999% fine. There is nothing wrong with having one aspirin a day if all it does is give you peace of mind...or a glass of beer...

Do get the socks as that will relieve stress on your legs.

Do get up and walk around during the flight. I flew around the world before I was diagnosed and I didn't get up much. I've never had any altitude problems.

Worst case scenario: Let a stewardess know that you may be prone to clotting just in case anything happens.

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And if you feel at all odd in your legs or chest when you get off the plane, make sure you go and see someone about it. Don't wait it out and see if it comes to anything.

I also flew long haul London-Mexico about 6 times before I was diagnosed and had no problems. Who knows why.

Most doctors will advise against treatment if you haven't had any episodes regardless of family history

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Thanks for your advice - It is appreciated. My Dr had never even heard of Protein S Defiency, so I was unsure whether to trust him.

Perhaps someone could answer a question that he couldn't; How often do I need to get my protein S level re-tested? I assume your level can change later in life?

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You should be checked at least once a month.
I think PrisonBull is suggesting the INR should be checked monthly, rather than the natural Protein S level.

The actual Protein S level seems to be largely unimportant compared to the knowledge that you have a family history and pre-disposition. Whether your Protein S levels are low or high the precautions remain the same.

Having recently taken my first long haul flights I has some concerns about my health upon my return, so I visited my doctor and we ran a D-Dimer test, which requires a finger-prick of blood on a test strip, to check for the presence of clotting factors signalling thrombosis. If you don't agree with your doctor withholding medication you may wish to consider the passive approach and take a testing kit with you. Instead of flight socks you could ask for medical grade compression stockings.

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You don't need an anti-coagulant if you are within normal ranges. One of the reasons for concern is the normally cramped conditions of a long-haul flight. You probably have nothing to fear. My personal emergence of PSD only occurred after receiving a slap shot to my ankle (only in Canada, eh?). I've been on many a plane prior + post diagnosis. I do/take nothing different than my normal meds and compression stockings when flying. My 'man-hose' as my wife so eloquently puts it. :unsure:

Just get up and walk around a bit during the flight. Normal advice for any traveler.

Sorry James! :(

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I fully expected (dare I say it, "wanted") to have heparin for my first long haul flight. My GP said it wasn't needed because I was already taking warfarin. I asked them to check with the local haematologist and he agreed with my GP. I still wasn't satisfied as I wasn't sure they thought a PSD patient was any different from a regular thrombophiliac. So I checked with a leading consultant haematologist and he agreed.

If my INR was out of range then maybe I would have been advised to take it but otherwise the advice seems to be swinging against using it on flights. Hydration, exercise and compression stockings appear to be higher priority precautions.

However, I was told that if I hadn't been on warfarin and had a clotting history then heparin would have been recommended. I have family members with PSD and clotting history that aren't taking warfarin so that would apply to them. However, I would have thought that it is discretionary for those with PSD that want to have therapeutic cover. You have to bear in mind though that anti-coagulants do come with associated bleeding risks.

n.b. don't ask for a seat next to an emergency exit because you have medical reasons - there is a requirement to be fit and healthy to be in one of those seats.

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I have PSD and have had a previous clotting episode (DVT in 2001). I have flown to America a few times over the last few years (8 -10 hr flights) and have had heparin prescribed for me.

I currently take no anticoagulants, haven't done for about 6 years but when I was diagnosed the haematologist said that at times of higher risk, ie pregnancy, prolonged bed rest, flying etc I should take some form of anticoagulant.

When I went to my GP about 2 years ago to get my first heparin prescription for flying she had never heard of PSD either and actually googled it while I was there and came across this site (I was just hoping she wouldn't come across any of my posts!). She wasn't entirely convinced that I needed the injections as she didn't seem to think that flying was a high risk activity (but she didn't think pregnancy was either :blink:) but in the end she gave me a prescription because she said that it wasn't going to do me any harm and it would give me peace of mind!

I also do the things that everyone is recommended to do, whether or not they have a clotting disorder, such as drink lots of water, exercise and wear my compression stockings.

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