In 2001, based on alarming previous reports of air travel–related venous thromboembolism (ATVT), the WHO organised a consultation in Geneva where industry experts agreed that there is probably an association between air travel and venous thromboembolism (VTE), but such an association is likely small and mainly affects passengers with additional risk for VTE. It was unanimous view of all these participants that further epidemiology, pathophysiological, multicentre, international and previous data be undertaken as soon as possible.

This led to the creation of the WRIGHT Project (WHO Research Initiative on Global Hazards of Travel) around 2005. The task force concluded that air travel is associated with an increased risk of VTE and the risk is slightly higher after exposure to a succession of flights; thrombin generation occurs in some individuals after an 8 hour flight, suggestion of flights that more than just immobilization causes ATVT; travelling for more than 4 hours by any transportation mode increases the risk of VTE twofold.

These long-haul RISK factors include personal internal risk factors (age more than 60 years, overweight, previous VTE (blood clot), recent surgery/hospitalisation/injury, pregnancy/postpartum, malignancy, cardiorespiratory diseases, thrombophilia, varicose veins, other chronic diseases, etc) and cabin related external risk factors (immobilisation, coach position, low air pressure, relative hypoxia, dehydration).

This increased risk applies to other forms of travel where travellers spend long periods seated and immobilised. Obesity, height, use of contraceptives/HRT, and the presence of prothrombotic/clotting abnormalities increase the risk. The results of the WRIGHT project suggest that over 150 000 of two billion air passengers per year will develop ATVT, of whom 7500 will suffer fatal PE. For this reason it is essential that the prevention study proposed for phase II of the WRIGHT project is carried out and that future passengers are adequately informed about their risk and the optimal mode of prevention.

It is hoped that these suggestions research projects will answer these question in the next few years!

At the moment collaboration consensus around prevention around cabin-related risk factors from the Conference on Traveler’s Thrombosis organized in Hall, Austria 2006 and an updated version published in 2008 that external risk factors can be remedied by drinking plenty of nonalcoholic fluids, moving feet and legs and taking deep breaths several times every hour while passenger-related risk factors that can trigger any of the factors in the physiological described Virchow’s triad and incorporates intravascular vessel wall damage, stasis of flow, and the presence of a hypercoagulable state.

It is for this reason we clinicians have come together to pre-empt and develop a solution of industry called Flying Health Program www.flyinghealthprogram.com that looks to consolidate pre-flight, in-flight and post-flight awareness, primary health and solution strategy’s to help travellers integrate better preventative health wellness into their everyday flying plans and thus helping users maximise their travel experiences and wellness.