Travel Plans On Warfarin: What You Need To Know

Warfarin is a commonly used anticoagulant, or blood thinner, that helps prevent harmful blood clots from forming or growing larger. While taking warfarin doesn't restrict you from travelling, there are several important considerations to keep in mind. Firstly, it's crucial to consult your doctor to ensure you're fit to travel, especially if you plan to visit high-altitude areas or are pregnant. Secondly, ensure you have an ample supply of warfarin for your trip, and always carry it with you, preferably with your anticoagulant therapy record booklet. Additionally, long-distance travel by car, train, coach, or plane can increase the risk of Deep Venous Thrombosis (DVT), so it's important to stay active and perform specific exercises to promote blood circulation.

Travel insurance considerations

When considering travel insurance, it is important to review the policy's coverage and exclusions. While travel insurance typically covers expenses related to trip cancellation, medical emergencies, evacuation, baggage loss, and accidental death or dismemberment, the specific circumstances under which these are covered can vary.

• Medical Coverage: Warfarin is a high-risk medication, and travellers are advised to consult their doctors before embarking on a trip. Ensure your travel insurance provides adequate medical coverage for any health issues that may arise due to your medication.
• Trip Cancellation: If your trip is cancelled due to a medical issue related to your Warfarin therapy, you may be covered by trip cancellation insurance. Review your policy to understand the specific conditions under which trip cancellation is covered.
• Evacuation and Repatriation: In the event of a medical emergency, evacuation insurance can cover the cost of transporting you to a suitable medical facility. Repatriation coverage will handle the necessary transportation arrangements in the event of death.
• Baggage Loss: Warfarin users are advised to carry their yellow anticoagulant therapy record booklet and recent pink appointment sheet with them when travelling. Ensure that your travel insurance covers the loss of these important documents, as well as any other personal items.
• Pre-existing Medical Conditions: It is crucial to disclose your use of blood-thinning medication to your insurance provider and ensure that your travel insurance covers pre-existing medical conditions related to your Warfarin therapy.
• Activity Considerations: Warfarin users are advised to avoid sitting still for long periods when travelling long distances to prevent Deep Venous Thrombosis (DVT). When participating in activities, especially adventurous ones, ensure your insurance covers any potential injuries that may be influenced by your use of anticoagulants.
• Dietary Changes: Dramatic changes in diet, such as increased consumption of green leafy vegetables, can affect the INR level and, consequently, the effectiveness of Warfarin. Be mindful of dietary changes when travelling, and ensure your insurance covers any potential issues arising from these changes.
• Alcohol Intake: Alcohol intake can also affect the INR level. Stick to safe intake levels, and be aware that the effects of alcohol are increased by cabin pressurisation when flying. Ensure your insurance covers any incidents related to alcohol consumption.
• International Travel: If travelling internationally, particularly to developing countries, ensure your insurance covers the complexities that may arise from extended travel and the use of Warfarin. This includes access to medical professionals who can monitor your INR levels and adjust your medication as needed.
• Medication Supply: Warfarin users should carry an adequate supply of their medication when travelling. Ensure your insurance covers any potential issues arising from medication supply, especially if you need to adjust your dosage during your trip.

Travelling by plane

Warfarin is a high-risk drug with a narrow therapeutic window, and those taking it need to be cautious when travelling. Here is some detailed advice for travelling by plane while taking warfarin:

Before Your Trip

• Consult your doctor to ensure you are fit to fly and discuss any specific health requirements.
• Obtain an up-to-date INR (International Normalized Ratio) reading before your trip. This will enable your doctor to advise you on the correct warfarin dosage to take while travelling.
• If you are travelling for an extended period or have a variable INR, consider investing in a personal INR monitor to allow for regular checks.
• Take your yellow anticoagulant therapy record booklet, your recent pink appointment sheet, and ensure you have an adequate supply of warfarin tablets.
• Inform the clinic of your departure date and how long you will be away.
• Check the regulations of your airline and destination country regarding the transportation of medication. Some may require additional documentation, especially for controlled substances.

During Your Trip

• Keep your medication in your carry-on luggage for easy access.
• Bring extra medication in case of delays.
• Adjust your medication schedule to account for time zone changes.
• Avoid making drastic changes to your diet. Warfarin interacts with vitamin K, so be mindful of your intake of green leafy vegetables.
• Limit your alcohol consumption. Cabin pressurisation increases the effects of alcohol, and excessive intake can affect your INR levels.
• Stay hydrated by drinking plenty of non-alcoholic liquids.
• Avoid sitting still for long periods to prevent Deep Venous Thrombosis (DVT). Move around the aircraft cabin as much as possible and perform simple exercises to improve blood circulation.
• Wear compression stockings, especially on long flights.

Travelling by car, train or coach

If you are taking warfarin, it is important to consult your doctor before travelling. Remember to take your yellow anticoagulant therapy record booklet, your recent pink appointment sheet, and an adequate supply of warfarin tablets.

Travelling by Car

When travelling by car, it is important to avoid sitting still for long periods of time, which can cause Deep Venous Thrombosis (DVT). To prevent this, drink plenty of non-alcoholic liquids and move around as often as possible. Ask the driver to stop once an hour so that you can take a brief walk. If this is not possible, do the following exercises regularly:

• Remove your shoes if they are tight.
• Bend your feet upwards.
• Spread your toes and count to three slowly.
• Point your feet downwards and curl your toes under you. Hold for another count of three.

Travelling by Train

On a train journey, stretch your legs regularly and walk to other carriages at least twice an hour. Perform the above exercises as well.

Travelling by Coach

On coach journeys lasting more than an hour, stand up occasionally and walk in the aisle if possible. If the coach stops briefly, take advantage of these breaks and go for a short walk. Perform the exercises described above while sitting.

Alcohol and diet

It is important to know the benefits and risks of drinking alcohol while taking warfarin. Alcohol affects the action of warfarin and can cause problems if consumed in large quantities or at the wrong time. To avoid this, it is recommended to drink the same amount of alcohol each day, avoiding big variations in daily consumption.

For men, it is safe to consume no more than 21 units of alcohol per week, and for women, no more than 15 units. One unit of alcohol is equivalent to a half-pint of ordinary-strength beer, lager, or cider, or a single measure of spirit. It is important to remember that drink strengths vary and are shown on drink labels.

Vitamin K-rich foods, such as dark green lettuce and liver, are very nutritious. Consistency in the intake of these foods is important as suddenly increasing or decreasing vitamin K in your diet can affect how well warfarin works. A balanced and varied diet is recommended, without the need to avoid vitamin K-rich foods entirely.

Travelling by Plane

If you are taking a long flight, ask your doctor about obtaining compression stockings, which should be worn before, during, and for three days after the flight. Drink plenty of non-alcoholic fluids and move around the aircraft cabin when it is safe to do so. Cabin pressurisation increases the effects of alcohol, so it is important to avoid drinking alcohol during the flight.

Medical procedures

If you are taking warfarin, it is important to consult your doctor before travelling to ensure that you are fit to travel and to discuss any specific health requirements. You should also inform the clinic of your departure date and how long you will be away.

• Get an up-to-date INR reading before you travel, ideally within one or two weeks of your trip. This will help your doctor determine the appropriate warfarin dosage for the following weeks.
• If you are travelling for an extended period or if your INR varies frequently, consider investing in your own INR monitor. This will allow you to perform regular INR checks with just a finger prick blood test.
• Always carry your yellow anticoagulant therapy record booklet, which contains your INR results and dosing information. In an emergency, this information is vital for healthcare providers.
• Continue taking your anticoagulant at the same time each day, even while travelling across time zones. Set an alarm on your phone or watch to ensure you don't miss a dose.
• Take a sufficient amount of medication with you, especially if you require different strengths of tablets for dosage adjustments. Never change your dosage without consulting a doctor.
• Be mindful of your diet and alcohol intake, as these can affect your INR level. Avoid making drastic changes to your consumption of green leafy vegetables, which are high in vitamin K and can impact clotting. Stick to safe alcohol intake levels, with a maximum of 2-3 units per day.
• If you plan to engage in adventurous activities, use reputable organisers and wear appropriate protective gear. Ensure that tour guides and event organisers are aware of your warfarin usage.
• If you become unwell, especially with a fever, rash, or bruising, seek medical advice promptly. If you need to take additional medication, inform the pharmacist or doctor of your anticoagulant usage.

Frequently asked questions