Clinical Decisions

Flying after Pulmonary Embolism

Pulmonary embolism blocks the arteries in the lungs. This will then cause shortness of breath and limits the amount of oxygen reaching the bloodstream from the lungs. Over time, the body will gradually recover. But in modern life, the question of flying after pulmonary embolism comes up often. Can I fly after a PE? How soon? Do I need testing before I can fly? All these are practical questions that come up. Often, finding the answers is not simple.

Why is Flying after Pulmonary Embolism a Problem?

Typically, the amount of oxygen on an airplane is lower than it is on the ground. This is because airplanes fly in altitudes where there is less oxygen. Obviously, the cabin pressure is controlled, but it is typically set to be lower than it is on the ground.

So, if someone has a breathing problem, flying can be dangerous. As clots in the lungs block some of the arteries in the lungs, flying after PE can be a problem.

A second issue is harder to explain. You may remember that the heart has two sides: left and right. The right side of the heart pumps blood to the lungs. If a pulmonary embolism blocks some of the lung arteries, that will make it harder for the right side of the heart to pump blood to that region. If that happens, the pressures in the right heart may go up. Unfortunately, that can be a problem, especially when flying. This is because the pressures can go up even further during flight. So if the right side of the heart is involved, flying can be even more problematic.

A third issue has to do with blood clots after flight. While millions of people fly, and most never develop blood clots, some do. And it turns out that statistically speaking, flying might increase the risk of clotting. So if someone had a pulmonary embolism, they may be at risk for more clots anyway. In these people, flying may not be as safe as in someone who has not had a clot. Of course, the added risk is not huge and not the same in everyone. But it is a theoretical risk to consider.

Is there Testing to Make Sure Flying is Safe?

The most accurate way to decide when flying after a pulmonary embolism is safe, it by something called a “altitude hypoxia testing“. Basically, we give the patient an air mixture that contains less oxygen. Then, we monitor the oxygen in their blood. If it does not drop, we can assume it will also be okay for them to fly.

But as this test is complicated and not always available, there are a few “rules of thumb” that we typically go by.

First, if a person needs oxygen on the ground, then flying (without oxygen) is definitely not safe for them.

Next, we ask the patient about their ability to perform a few simple tasks. Typically, if a person can climb a couple flights of stairs without much difficulty and without the oxygen level in their blood dropping, that is a good sign.

Finally, if a person is still taking a blood thinner, that is actually a good thing, from a flying perspective. This is because they are practically protected from more clots.

Pro Tip

If you are flying for the first time after your PE, here is a practical tip to consider. While we all want to arrive at our destination at the quickest possible time, sometimes breaking up the trip might be safer. So if you are flying over a substantial distance, consider breaking up the flight into legs. Perhaps the first leg can be especially short. That way, if any problems arise, you will be able to abort and avoid the next flight, without suffering significant harm.

Safe travels!

Dr. Ido Weinberg

Dr. Ido Weinberg is a Vascular Medicine specialist at Massachusetts General Hospital. He is President-Elect of the Society for Vascular Medicine. Dr. Weinberg treats hundreds of patients with blood clots every year. He publishes extensively on blood clots and he speaks frequently about blood clots in international conferences.

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