Travel and VTE
SIDEBAR
Recommendations
from the ASH
Guidelines for VTE
Prophylaxis in Long-
Distance Travelers
≥5-hour-long flight. No symptomatic DVTs developed in either
group, but wearing compression stockings did decrease signifi-
cantly symptomless DVT compared with no stockings (p<0.001).
No adverse effects from compression stockings were reported in
studies that assessed tolerability.
Most of the literature related to prophylactic use of LMWH is
narrative or from systematic reviews, according to the guideline.
Only one small randomized trial was found: LONFLIT3. 10
The study randomized 300 patients at high risk for VTE to receive
either no prophylaxis, aspirin 400 mg, or LMWH (enoxaparin). Of
the 249 patients who completed the study, no LMWH-treated patients
experienced a DVT, compared with 4.82 percent of control patients
and 3.6 percent of aspirin-treated patients. However, 60 percent of the
DVTs were asymptomatic. 10
In her own practice, Dr. O’Connell commented, “in someone
with a remote history of DVT from a provoking event like orthope-
dic surgery, I would not suggest LMWH for every flight longer than
four hours. On the other hand, for someone with a symptomatic and
proximal DVT treated in the last year, I would consider a prophy-
lactic dose of LMWH for a long flight, particularly if there was no
provoking event.”
Finally, the ASH guidelines recommend that, in patients at high
Who is at increased risk?
The following factors place people
at an increased risk for developing
VTE:
• recent surgery
• prior VTE
• postpartum women
• active malignancy
• ≥2 risk factors, including
combinations of the above
with hormonal replacement
therapy, obesity, or pregnancy
The First and Only Treatment for
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FROM A DEADLY DISEASE
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How long is “long-distance?”
Long-distance travel is defined
as travel longer than four hours
in duration.
Who should wear graduated
compression stockings or take low-
molecular-weight heparin (LMWH)
or aspirin for VTE prophylaxis?
In long-distance travelers without
risk factors for VTE, the ASH
guideline panel suggests not
using these measures.
However, the ASH guidelines
panel suggests using graduated
compression stockings or
prophylactic LMWH for long-
distance travelers who are at
substantially increased VTE risk.
What if a patient cannot wear
graduated compression
stockings or take LMWH?
For long-distance travelers
who are at an increased risk
of VTE but who are unable
or unwilling to use LMWH
or graduated compression
stockings (due to resource
constraints or aversion to other
indicated anticoagulants), the
ASH guideline panel suggests
using aspirin rather than no VTE
prophylaxis.
Source: Schunemann HJ, Cushman M, Burnett
AE, et al. American Society of Hematology
2018 guidelines for management of venous
thromboembolism: prophylaxis for hospitalized
and nonhospitalized medical patients. Blood Adv.
2018;2:3198-225.
INDICATION
• ELZONRIS is a CD123-directed cytotoxin for the treatment of
blastic plasmacytoid dendritic cell neoplasm (BPDCN) in adults
and in pediatric patients 2 years and older
IMPORTANT SAFETY INFORMATION
Boxed WARNING: CAPILLARY LEAK SYNDROME
• Capillary Leak Syndrome (CLS), which may be life-threatening or
fatal, can occur in patients receiving ELZONRIS. Monitor for signs
and symptoms of CLS and take actions as recommended
WARNINGS AND PRECAUTIONS
Capillary Leak Syndrome
• ELZONRIS can cause capillary leak syndrome (CLS), which may
be life-threatening or fatal if not properly managed. The overall
incidence of CLS in clinical trials was 55% in patients receiving
ELZONRIS, including 46% in Grades 1 or 2, 6% in Grade 3,
1% in Grade 4, and 2 fatal events. Common signs and
symptoms (incidence ≥ 20%) associated with CLS that were
reported during treatment with ELZONRIS include
hypoalbuminemia, edema, weight gain, and hypotension
• Before initiating therapy with ELZONRIS, ensure that the patient
has adequate cardiac function and serum albumin is ≥ 3.2 g/dL
• During treatment with ELZONRIS, ensure that serum albumin
levels are ≥ 3.5 g/dL and have not been reduced by ≥ 0.5 g/dL
from the albumin value measured prior to dosing initiation of
the current cycle. Monitor serum albumin levels prior to the
initiation of each dose or more often as indicated clinically
thereafter. Additionally, assess patients for other signs or
symptoms of CLS, including weight gain, new onset or
worsening edema including pulmonary edema, hypotension,
or hemodynamic instability
• Counsel patients to seek immediate medical attention should
signs or symptoms of CLS occur at any time
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