Drive + Fly: Difference between revisions
From IDWiki
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− | == |
+ | ==Driving== |
− | === |
+ | ===Coronary Artery Disease (CAD)=== |
+ | {| class="wikitable" |
||
− | {| |
||
− | ! |
+ | !Syndrome |
− | ! |
+ | !Private |
− | ! |
+ | !Commercial |
|- |
|- |
||
− | | |
+ | |STEMI |
− | | |
+ | |1 mo from D/C |
− | | |
+ | |3 mo from D/C |
|- |
|- |
||
− | | |
+ | |NSTEMI with sig LV damage |
− | | |
+ | |1 mo from D/C |
− | | |
+ | |3 mo from D/C |
|- |
|- |
||
− | | |
+ | |NSTEMI with PCI |
− | | |
+ | |48 h after PCI |
− | | |
+ | |7 days after PCI |
|- |
|- |
||
− | | |
+ | |NSTEMI without PCI |
− | | |
+ | |7 days after D/C |
− | | |
+ | |30 days after D/C |
|- |
|- |
||
− | | |
+ | |Unstable angina with PCI |
− | | |
+ | |48 h after PCI |
− | | |
+ | |7 days after PCI |
|- |
|- |
||
− | | |
+ | |Unstable angina without PCI |
− | | |
+ | |7 days after D/C |
− | | |
+ | |30 days after D/C |
|- |
|- |
||
− | | |
+ | |Stable angina or asymptomatic CAD |
− | | |
+ | |No restriction |
− | | |
+ | |No restriction |
|- |
|- |
||
− | | |
+ | |Stable CAD with PCI |
− | | |
+ | |48 h after PCI |
− | | |
+ | |7 days after PCI |
|- |
|- |
||
− | | |
+ | |CABG |
− | | |
+ | |1 mo after D/C |
− | | |
+ | |3 mo after D/C |
|- |
|- |
||
− | | |
+ | |Any, with 50% left main |
| |
| |
||
− | | |
+ | |Disqualified until treated |
|- |
|- |
||
− | | |
+ | |Any, with 70% left main |
− | | |
+ | |Disqualified until treated |
| |
| |
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|} |
|} |
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Minor/non-significant LV damage is the abscence of new wall motion abnormality |
Minor/non-significant LV damage is the abscence of new wall motion abnormality |
||
− | === |
+ | ===Dysrhythmias=== |
+ | {| class="wikitable" |
||
− | {| |
||
− | ! |
+ | !Syndrome |
− | ! |
+ | !Private |
− | ! |
+ | !Commercial |
|- |
|- |
||
− | | |
+ | |VF without reversible cause |
− | | |
+ | |6 mo after event |
− | | |
+ | |Disqualified |
|- |
|- |
||
− | | |
+ | |Unstable VT |
− | | |
+ | |6 mo after event |
− | | |
+ | |Disqualified |
|- |
|- |
||
− | | |
+ | |VT or VF with reversible cause |
− | | |
+ | |Until cause is treated |
− | | |
+ | |Until cause is treated |
|- |
|- |
||
− | | |
+ | |Sustained VT, LVEF <30% |
− | | |
+ | |3 mo after event & controlled |
− | | |
+ | |Disqualified |
|- |
|- |
||
− | | |
+ | |Sustained VT, LVEF ≥30% |
− | | |
+ | |4 wk after event & controlled |
− | | |
+ | |3 mo after event |
|- |
|- |
||
− | | |
+ | |NSVT |
− | | |
+ | |No restriction |
− | | |
+ | |No restriction |
|- |
|- |
||
− | | |
+ | |Paroxysmal SVT/AF with impaired LOC |
− | | |
+ | |When controlled |
− | | |
+ | |When controlled |
|- |
|- |
||
− | | |
+ | |SVT/AF without impaired LOC |
− | | |
+ | |No restriction |
− | | |
+ | |No restriction |
|- |
|- |
||
− | | |
+ | |Symptomatic SSS |
− | | |
+ | |Until treated |
− | | |
+ | |Until treated |
|} |
|} |
||
AF = atrial fibrillation or flutter |
AF = atrial fibrillation or flutter |
||
− | ==== |
+ | ====Heart Block==== |
+ | {| class="wikitable" |
||
− | {| |
||
− | ! |
+ | !Syndrome |
− | ! |
+ | !Private |
− | ! |
+ | !Commercial |
|- |
|- |
||
− | | |
+ | |Isolated 1º HB |
− | | |
+ | |No restriction |
− | | |
+ | |No restriction |
|- |
|- |
||
− | | |
+ | |Isolated RBBB |
− | | |
+ | |No restriction |
− | | |
+ | |No restriction |
|- |
|- |
||
− | | |
+ | |Isolated LAFB |
− | | |
+ | |No restriction |
− | | |
+ | |No restriction |
|- |
|- |
||
− | | |
+ | |Isolated LPFB |
− | | |
+ | |No restriction |
− | | |
+ | |No restriction |
|- |
|- |
||
− | | |
+ | |LBBB |
− | | |
+ | |If no impaired LOC |
− | | |
+ | |If no impaired LOC* |
|- |
|- |
||
− | | |
+ | |Bifascicular block |
− | | |
+ | |If no impaired LOC |
− | | |
+ | |If no impaired LOC* |
|- |
|- |
||
− | | |
+ | |2º HB, Mobitz I |
− | | |
+ | |If no impaired LOC |
− | | |
+ | |If no impaired LOC* |
|- |
|- |
||
− | | |
+ | |1º HB with bifascicular block |
− | | |
+ | |If no impaired LOC |
− | | |
+ | |If no impaired LOC* |
|- |
|- |
||
− | | |
+ | |2º HB, Mobitz II |
− | | |
+ | |Disqualified |
− | | |
+ | |Disqualified |
|- |
|- |
||
− | | |
+ | |Alternating LBBB & RBBB |
− | | |
+ | |Disqualified |
− | | |
+ | |Disqualified |
|- |
|- |
||
− | | |
+ | |Acquired 3º HB |
− | | |
+ | |Disqualified |
− | | |
+ | |Disqualified |
|- |
|- |
||
− | | |
+ | |Congenital 3º HB |
− | | |
+ | |If no impaired LOC |
− | | |
+ | |If no impaired LOC** |
|} |
|} |
||
− | * |
+ | *and no higher block on annual 24 h Holter ** and QRS ≤110, and no pauses ≥3 sec on annual 24 H holter |
− | ==== |
+ | ====Pacemakers and ICDs==== |
+ | {| class="wikitable" |
||
− | {| |
||
− | ! |
+ | !Syndrome |
− | ! |
+ | !Private |
− | ! |
+ | !Commercial |
|- |
|- |
||
− | | |
+ | |PPM |
− | | |
+ | |1 wk after implant* |
− | | |
+ | |1 mo after implant* |
|- |
|- |
||
− | | |
+ | |ICD for 1º prophylaxis |
− | | |
+ | |4 wk after implant |
− | | |
+ | |Disqualified |
|- |
|- |
||
− | | |
+ | |ICD for symptomatic VF/VT |
− | | |
+ | |6 mo after event |
− | | |
+ | |Disqualified |
|- |
|- |
||
− | | |
+ | |ICD for sustained VT |
− | | |
+ | |1 wk after implant |
− | | |
+ | |Disqualified |
|- |
|- |
||
− | | |
+ | |ICD giving shocks |
− | | |
+ | |6 mo after event |
− | | |
+ | |Disqualified |
|} |
|} |
||
− | * |
+ | *as well as no impaired LOC, normal sensing and capture, and no evidence of PPM malfunction |
− | ==== |
+ | ====Other Dysrhythmias==== |
+ | {| class="wikitable" |
||
− | {| |
||
− | ! |
+ | !Syndrome |
− | ! |
+ | !Private |
− | ! |
+ | !Commercial |
|- |
|- |
||
− | | |
+ | |Brugada, long QT, or arrhythmogenic RV cardiomyopathy |
− | | |
+ | |Once investigated |
− | | |
+ | |Disqualified |
|- |
|- |
||
− | | |
+ | |Cather ablation |
− | | |
+ | |48 h after D/C |
− | | |
+ | |1 wk after D/C |
|} |
|} |
||
− | === |
+ | ===Syncope=== |
+ | {| class="wikitable" |
||
− | {| |
||
− | ! |
+ | !Syndrome |
− | ! |
+ | !Private |
− | ! |
+ | !Commercial |
|- |
|- |
||
− | | |
+ | |1x vasovagal |
− | | |
+ | |No restriction |
− | | |
+ | |No restriction |
|- |
|- |
||
− | | |
+ | |Treated cause (e.g. with PPM) |
− | | |
+ | |1 wk after treatment |
− | | |
+ | |1 mo after treatment |
|- |
|- |
||
− | | |
+ | |Reversible cause (e.g. dehydration) |
− | | |
+ | |After treatment |
− | | |
+ | |After treatment |
|- |
|- |
||
− | | |
+ | |Situational syncope with avoidable trigger |
− | | |
+ | |1 wk after episode |
− | | |
+ | |1 wk after episode |
|- |
|- |
||
− | | |
+ | |1x unexplained |
− | | |
+ | |1 wk after episode |
− | | |
+ | |12 mo after episode |
|- |
|- |
||
− | | |
+ | |Recurrent vasovagal in 12 mo |
− | | |
+ | |1 wk after episode |
− | | |
+ | |12 mo after episode |
|- |
|- |
||
− | | |
+ | |Recurrent unexplained in 12 mo |
− | | |
+ | |3 mo after episode |
− | | |
+ | |12 mo after episode |
|- |
|- |
||
− | | |
+ | |Due to arrhythmia |
− | | |
+ | |See Dysrhythmia section |
− | | |
+ | |See Dysrhythmia section |
|} |
|} |
||
− | === |
+ | ===Valvular Disease=== |
+ | {| class="wikitable" |
||
− | {| |
||
− | ! |
+ | !Syndrome |
− | ! |
+ | !Private |
− | ! |
+ | !Commerical |
|- |
|- |
||
− | | |
+ | |AS |
− | | |
+ | |NYHA I or II with no impaired LOC |
− | | |
+ | |Asymptomatic, NYHA I, AVA ≥1cm, EF ≥35% |
|- |
|- |
||
− | | |
+ | |AR/MS/MR |
− | | |
+ | |NYHA I or II with no impaired LOC |
− | | |
+ | |No impaired LOC, NYHA I, EF ≥35% |
|- |
|- |
||
− | | |
+ | |Mechanical valve<br />BioMVR or MV repair with AF |
− | | |
+ | |6 wk from D/C<br />No embolic, on A/C |
− | | |
+ | |3 mo from D/C<br />No embolic, on A/C, NYHA I, EF ≥35% |
|- |
|- |
||
− | | |
+ | |BioAVR<br />BioMVR or MV repair without AF |
− | | |
+ | |6 wk after D/C<br />No embolic |
− | | |
+ | |3 mo after D/C<br />No embolic, NYHA I, EF ≥35% |
|} |
|} |
||
− | === |
+ | ===Heart Failure=== |
+ | {| class="wikitable" |
||
− | {| |
||
− | ! |
+ | !Syndrome |
− | ! |
+ | !Private |
− | ! |
+ | !Commercial |
|- |
|- |
||
− | | |
+ | |NYHA I |
− | | |
+ | |No restriction |
− | | |
+ | |EF ≥35% |
|- |
|- |
||
− | | |
+ | |NYHA II |
− | | |
+ | |No restriction |
− | | |
+ | |EF ≥35% |
|- |
|- |
||
− | | |
+ | |NYHA III |
− | | |
+ | |No restriction |
− | | |
+ | |Disqualified |
|- |
|- |
||
− | | |
+ | |NYHA IV |
− | | |
+ | |Disqualified |
− | | |
+ | |Disqualified |
|- |
|- |
||
− | | |
+ | |Receiving inotropes |
− | | |
+ | |Disqualified |
− | | |
+ | |Disqualified |
|- |
|- |
||
− | | |
+ | |LVAD |
− | | |
+ | |Disqualified |
− | | |
+ | |Disqualified |
|- |
|- |
||
− | | |
+ | |Heart transplant |
− | | |
+ | |6 wk after D/C<br />NYHA I or II, on stable Rx |
− | | |
+ | |6 mo after D/C<br />EF ≥35%, NYHA I<br />No evidence of ischemia on testing |
|} |
|} |
||
− | === |
+ | ===Hypertrophic Cardiomyopathy=== |
− | * |
+ | *Private: no impaired LOC |
− | * |
+ | *Commercial: LV wall thickness <30 mm, no syncope, no NSVT on annual 24 h Holter, no FHx sudden death at young age, and no hypotension with exercise |
− | == |
+ | ==Flying== |
+ | {| class="wikitable" |
||
− | {| |
||
− | ! |
+ | !Condition |
− | ! |
+ | !NYHA |
− | ! |
+ | !Travel |
|- |
|- |
||
− | | |
+ | |Angina |
− | | |
+ | |I/II |
− | | |
+ | |No restriction |
|- |
|- |
||
− | | |
+ | |Angina |
− | | |
+ | |III |
− | | |
+ | |Supplemental oxygen required |
|- |
|- |
||
− | | |
+ | |Angina |
− | | |
+ | |IV |
− | | |
+ | |Only if medically necessary and accompanied |
|- |
|- |
||
− | | |
+ | |Recent MI |
− | | |
+ | |I |
− | | |
+ | |1 to 2 weeks for repatriation if uncomplicated and revascularized<br />6 to 8 weeks for elective travel |
|- |
|- |
||
− | | |
+ | |Heart failure |
− | | |
+ | |I/II |
− | | |
+ | |Unrestricted |
|- |
|- |
||
− | | |
+ | |Heart failure |
− | | |
+ | |III |
− | | |
+ | |Supplemental oxygen required |
|- |
|- |
||
− | | |
+ | |Valvular disease |
− | | |
+ | |I/II |
− | | |
+ | |Unrestricted; supplemental oxygen if pulmonary hypertension |
|- |
|- |
||
− | | |
+ | |Valvular disease |
− | | |
+ | |III |
− | | |
+ | |Supplemental oxygen required |
|- |
|- |
||
− | | |
+ | |Valvular disease |
− | | |
+ | |IV |
− | | |
+ | |Only if medically necessary and accompanied |
|- |
|- |
||
− | | |
+ | |Congenital |
− | | |
+ | |I/II |
− | | |
+ | |Unrestricted; supplemental oxygen if PaO2 <70 mmHg |
|- |
|- |
||
− | | |
+ | |Congenital |
− | | |
+ | |III |
− | | |
+ | |Supplemental oxygen required |
|- |
|- |
||
− | | |
+ | |Congenital |
− | | |
+ | |IV |
− | | |
+ | |Only if medically necessary and accompanied |
|- |
|- |
||
− | | |
+ | |Recent CABG/valve surgery |
− | | |
+ | |I/II |
− | | |
+ | |4 days post-surgery if Hb ≥90 and flight <2 h<br />7 days post-surgery if Hb ≥90 and flight ≤2 h |
|- |
|- |
||
− | | |
+ | |PCI/ASD closure |
− | | |
+ | |I/II |
− | | |
+ | |1 day postprocedure<br />If PCI, following CAD guidelines, above |
|- |
|- |
||
− | | |
+ | |Post-arrhythmia procedure |
− | | |
+ | |I/II |
− | | |
+ | |Well-controlled SVT: unrestricted<br />1 day post-procedure for SVT<br />2 days post-procedure for ventricular arrhythmias |
|- |
|- |
||
− | | |
+ | |Post-arrhythmia procedure |
− | | |
+ | |III/IV |
− | | |
+ | |Uncontrolled hemodynamically significant ventricular arrhythmias should not fly |
|- |
|- |
||
− | | |
+ | |Post-PPM/ICD/loop recorder |
− | | |
+ | |I/II |
− | | |
+ | |1 day post-implant if no pneumothorax, and device is functioning |
|- |
|- |
||
− | | |
+ | |ICD patients |
− | | |
+ | |I/II |
− | | |
+ | |1 mo following last shock associated with severe presyncope or syncope |
|} |
|} |
||
− | === |
+ | ===DVT Prophylaxis=== |
Routine precautions include: |
Routine precautions include: |
||
− | * |
+ | *Avoid stasis, move around cabin, isometric calf exercises |
− | * |
+ | *Avoid dehydration, alcohol, and caffeine |
+ | {| class="wikitable" |
||
− | {| |
||
− | ! |
+ | !Patient Population |
− | ! |
+ | !Recommendations |
|- |
|- |
||
− | | |
+ | |Flight <12 h |
− | | |
+ | |Routine |
|- |
|- |
||
− | | |
+ | |Flight ≥12 h, low risk |
− | | |
+ | |Routine |
|- |
|- |
||
− | | |
+ | |Flight ≥12 h, moderate risk |
− | | |
+ | |Routine with pressure stockings or ASA 160-325 mg 4 h before flight |
|- |
|- |
||
− | | |
+ | |Flight ≥12 h, high risk |
− | | |
+ | |Routine with pressure stockings or LMWH 2 h before flight |
|} |
|} |
||
− | * |
+ | *'''Moderate risk:''' patients aged >75 years, women >45 on estrogen, pregnant or post-partum women, age <45 years with heterozygous FVL or prothrombin mutations, patients with varicose veins, heart failure, MI within 6 weeks, or lower limb trauma within 6 weeks |
− | * |
+ | *'''High risk:''' previous VTE, major surgery within 6 weeks, active malignancy, gross obesity or marked immobility due to neuromuscular or cardiorespiratory disease, people age >45 with antithrombin/protein C/protein S deficiency, people age >75 with cardiac or pulmonary disease |
− | == |
+ | ==Further Reading== |
− | * |
+ | *[https://ccs.ca/images/Guidelines/Guidelines_POS_Library/DF_CC_2003_ES.pdf CCS Consensus Conference 2003: Assessment of the cardiac patient for fitness to drive and fly – Executive summary] |
[[Category:Guidelines]] |
[[Category:Guidelines]] |
Latest revision as of 08:50, 14 May 2021
Driving
Coronary Artery Disease (CAD)
Syndrome | Private | Commercial |
---|---|---|
STEMI | 1 mo from D/C | 3 mo from D/C |
NSTEMI with sig LV damage | 1 mo from D/C | 3 mo from D/C |
NSTEMI with PCI | 48 h after PCI | 7 days after PCI |
NSTEMI without PCI | 7 days after D/C | 30 days after D/C |
Unstable angina with PCI | 48 h after PCI | 7 days after PCI |
Unstable angina without PCI | 7 days after D/C | 30 days after D/C |
Stable angina or asymptomatic CAD | No restriction | No restriction |
Stable CAD with PCI | 48 h after PCI | 7 days after PCI |
CABG | 1 mo after D/C | 3 mo after D/C |
Any, with 50% left main | Disqualified until treated | |
Any, with 70% left main | Disqualified until treated |
Minor/non-significant LV damage is the abscence of new wall motion abnormality
Dysrhythmias
Syndrome | Private | Commercial |
---|---|---|
VF without reversible cause | 6 mo after event | Disqualified |
Unstable VT | 6 mo after event | Disqualified |
VT or VF with reversible cause | Until cause is treated | Until cause is treated |
Sustained VT, LVEF <30% | 3 mo after event & controlled | Disqualified |
Sustained VT, LVEF ≥30% | 4 wk after event & controlled | 3 mo after event |
NSVT | No restriction | No restriction |
Paroxysmal SVT/AF with impaired LOC | When controlled | When controlled |
SVT/AF without impaired LOC | No restriction | No restriction |
Symptomatic SSS | Until treated | Until treated |
AF = atrial fibrillation or flutter
Heart Block
Syndrome | Private | Commercial |
---|---|---|
Isolated 1º HB | No restriction | No restriction |
Isolated RBBB | No restriction | No restriction |
Isolated LAFB | No restriction | No restriction |
Isolated LPFB | No restriction | No restriction |
LBBB | If no impaired LOC | If no impaired LOC* |
Bifascicular block | If no impaired LOC | If no impaired LOC* |
2º HB, Mobitz I | If no impaired LOC | If no impaired LOC* |
1º HB with bifascicular block | If no impaired LOC | If no impaired LOC* |
2º HB, Mobitz II | Disqualified | Disqualified |
Alternating LBBB & RBBB | Disqualified | Disqualified |
Acquired 3º HB | Disqualified | Disqualified |
Congenital 3º HB | If no impaired LOC | If no impaired LOC** |
- and no higher block on annual 24 h Holter ** and QRS ≤110, and no pauses ≥3 sec on annual 24 H holter
Pacemakers and ICDs
Syndrome | Private | Commercial |
---|---|---|
PPM | 1 wk after implant* | 1 mo after implant* |
ICD for 1º prophylaxis | 4 wk after implant | Disqualified |
ICD for symptomatic VF/VT | 6 mo after event | Disqualified |
ICD for sustained VT | 1 wk after implant | Disqualified |
ICD giving shocks | 6 mo after event | Disqualified |
- as well as no impaired LOC, normal sensing and capture, and no evidence of PPM malfunction
Other Dysrhythmias
Syndrome | Private | Commercial |
---|---|---|
Brugada, long QT, or arrhythmogenic RV cardiomyopathy | Once investigated | Disqualified |
Cather ablation | 48 h after D/C | 1 wk after D/C |
Syncope
Syndrome | Private | Commercial |
---|---|---|
1x vasovagal | No restriction | No restriction |
Treated cause (e.g. with PPM) | 1 wk after treatment | 1 mo after treatment |
Reversible cause (e.g. dehydration) | After treatment | After treatment |
Situational syncope with avoidable trigger | 1 wk after episode | 1 wk after episode |
1x unexplained | 1 wk after episode | 12 mo after episode |
Recurrent vasovagal in 12 mo | 1 wk after episode | 12 mo after episode |
Recurrent unexplained in 12 mo | 3 mo after episode | 12 mo after episode |
Due to arrhythmia | See Dysrhythmia section | See Dysrhythmia section |
Valvular Disease
Syndrome | Private | Commerical |
---|---|---|
AS | NYHA I or II with no impaired LOC | Asymptomatic, NYHA I, AVA ≥1cm, EF ≥35% |
AR/MS/MR | NYHA I or II with no impaired LOC | No impaired LOC, NYHA I, EF ≥35% |
Mechanical valve BioMVR or MV repair with AF |
6 wk from D/C No embolic, on A/C |
3 mo from D/C No embolic, on A/C, NYHA I, EF ≥35% |
BioAVR BioMVR or MV repair without AF |
6 wk after D/C No embolic |
3 mo after D/C No embolic, NYHA I, EF ≥35% |
Heart Failure
Syndrome | Private | Commercial |
---|---|---|
NYHA I | No restriction | EF ≥35% |
NYHA II | No restriction | EF ≥35% |
NYHA III | No restriction | Disqualified |
NYHA IV | Disqualified | Disqualified |
Receiving inotropes | Disqualified | Disqualified |
LVAD | Disqualified | Disqualified |
Heart transplant | 6 wk after D/C NYHA I or II, on stable Rx |
6 mo after D/C EF ≥35%, NYHA I No evidence of ischemia on testing |
Hypertrophic Cardiomyopathy
- Private: no impaired LOC
- Commercial: LV wall thickness <30 mm, no syncope, no NSVT on annual 24 h Holter, no FHx sudden death at young age, and no hypotension with exercise
Flying
Condition | NYHA | Travel |
---|---|---|
Angina | I/II | No restriction |
Angina | III | Supplemental oxygen required |
Angina | IV | Only if medically necessary and accompanied |
Recent MI | I | 1 to 2 weeks for repatriation if uncomplicated and revascularized 6 to 8 weeks for elective travel |
Heart failure | I/II | Unrestricted |
Heart failure | III | Supplemental oxygen required |
Valvular disease | I/II | Unrestricted; supplemental oxygen if pulmonary hypertension |
Valvular disease | III | Supplemental oxygen required |
Valvular disease | IV | Only if medically necessary and accompanied |
Congenital | I/II | Unrestricted; supplemental oxygen if PaO2 <70 mmHg |
Congenital | III | Supplemental oxygen required |
Congenital | IV | Only if medically necessary and accompanied |
Recent CABG/valve surgery | I/II | 4 days post-surgery if Hb ≥90 and flight <2 h 7 days post-surgery if Hb ≥90 and flight ≤2 h |
PCI/ASD closure | I/II | 1 day postprocedure If PCI, following CAD guidelines, above |
Post-arrhythmia procedure | I/II | Well-controlled SVT: unrestricted 1 day post-procedure for SVT 2 days post-procedure for ventricular arrhythmias |
Post-arrhythmia procedure | III/IV | Uncontrolled hemodynamically significant ventricular arrhythmias should not fly |
Post-PPM/ICD/loop recorder | I/II | 1 day post-implant if no pneumothorax, and device is functioning |
ICD patients | I/II | 1 mo following last shock associated with severe presyncope or syncope |
DVT Prophylaxis
Routine precautions include:
- Avoid stasis, move around cabin, isometric calf exercises
- Avoid dehydration, alcohol, and caffeine
Patient Population | Recommendations |
---|---|
Flight <12 h | Routine |
Flight ≥12 h, low risk | Routine |
Flight ≥12 h, moderate risk | Routine with pressure stockings or ASA 160-325 mg 4 h before flight |
Flight ≥12 h, high risk | Routine with pressure stockings or LMWH 2 h before flight |
- Moderate risk: patients aged >75 years, women >45 on estrogen, pregnant or post-partum women, age <45 years with heterozygous FVL or prothrombin mutations, patients with varicose veins, heart failure, MI within 6 weeks, or lower limb trauma within 6 weeks
- High risk: previous VTE, major surgery within 6 weeks, active malignancy, gross obesity or marked immobility due to neuromuscular or cardiorespiratory disease, people age >45 with antithrombin/protein C/protein S deficiency, people age >75 with cardiac or pulmonary disease