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The guidelines1 drawn up on prevention of venous thromboembolism and long haul flights should be welcomed, though seen in the light of incomplete evidence. We would like to draw attention to several points.
Scurr et al2 looked prospectively at a group aged over 50 years undergoing long haul travel from which anyone with recognised risk factors was excluded, putting such individuals into a low risk group for venous thromboembolism. Twelve of 116 people who were randomised to the “no stocking” group were diagnosed with symptomless calf deep vein thrombosis after their long haul travel. None of the group randomised to wear compression stockings developed deep vein thrombosis. Even if we take this surprising finding at face value, we are left with the question: what is the clinical significance of asymptomatic calf deep vein thrombosis in a low risk population? It is far from clear in such a low risk group that we need to treat such events, which weakens any guideline aimed at prevention. Unlike a postoperative patient, the traveller …