Letters Section Editor: Jody W. Zylke, MD, Senior Editor.
Author Affiliations: Department of Cardiovascular Sciences, University of Leicester, Leicester, England (Dr Toff); Virginia Commonwealth University, Richmond (Dr Sugerman; email@example.com); and University of Hawaii School of Medicine, Honolulu (Dr Eklöf).
In Reply: Dr Sokol raises an important issue. We subscribe to the doctrine of primum non nocere and would certainly not recommend indiscriminate use of LMWH in patients at increased risk of venous thrombosis during air travel.
The principal aim of the Patient Page was to draw public attention to the simplest preventive measure to reduce the risk of venous thrombosis during prolonged air travel, which is to exercise the legs. This is applicable to all people undertaking long or multiple airplane flights and to anyone who is seated and relatively immobile for a prolonged period, whether at a desk, in a motor vehicle, or on a train.
Toff WD, Sugerman H, Eklöf BG. Venous Thrombosis Related to Air Travel—Reply. JAMA. 2013;309(13):1347. doi:10.1001/jama.2013.1343