Traveling by Plane After a Stroke: Safety Tips for Patients

Flying After a Stroke

Hello Doctor, my father is 58 years old.
He had a mild stroke in early November 2021 (at that time, he was unable to speak, had complete weakness in his limbs, and was unable to manage his bowel and bladder functions, so he could only lie in bed).
He has since gradually rehabilitated to the point where he can walk slowly, but he cannot walk long distances.
His blood pressure is approximately 135/75, and he has been undergoing dialysis since 2018.
He also had coronary artery bypass surgery at the end of 2018.
I would like to ask if it would be dangerous for my father to fly to Ho Chi Minh City, Vietnam this year, and if there are any special precautions we should take.

Hua Zai, 20~29 year old female. Ask Date: 2023/04/06

Dr. Jiang Junyi reply Neurology

Dear Mr.
Hua,
You mentioned that your father "had a stroke in 2021...
has been undergoing dialysis since 2018, and underwent coronary artery bypass surgery at the end of 2018." Generally, for stroke patients, it is recommended to wait at least 2-4 weeks after the stroke before flying, although the duration may vary depending on the severity of the stroke.
It seems that your father's stroke has already surpassed the observation period.
Commercial aircraft typically fly at altitudes of 5,000 to 8,000 feet, where cabin pressure and alveolar oxygen partial pressure are reduced.
During flight, blood oxygen saturation levels can sometimes drop to 90%, which may be intolerable for individuals with neurological, cardiac, or respiratory conditions, or anemia.
Additionally, the risk of venous thromboembolism increases with the duration of the flight, with risk factors including obesity, very high altitudes, and coagulopathy.
To reduce the risks associated with flying, I recommend the following measures:
1.
If possible, consider seeking an air medical transport team for continuous monitoring.
2.
Consult with a travel medicine specialist for an evaluation and to obtain a fitness-to-fly certificate.
3.
Opt for business class seating to reduce the risk of venous thrombosis and orthostatic hypotension during the flight.
4.
Ensure adequate hemoglobin levels (dialysis patients often have anemia, and patients with coronary artery disease are prone to arrhythmias due to anemia).
Monitor blood oxygen levels during the flight to ensure they remain above 94%, and consider renting supplemental oxygen.
Thank you for your inquiry.
If you have further questions, feel free to discuss them!
Wishing you good health and peace,
Dr.
Jiang Junyi, Taoyuan Medical Center

Reply Date: 2023/04/06

More Info

Traveling by plane after experiencing a stroke can be a complex decision that requires careful consideration of various health factors. Your father's medical history, including his stroke, ongoing dialysis, and previous heart surgery, necessitates a thorough evaluation before undertaking air travel.

Safety Considerations for Air Travel After a Stroke
1. Timing Post-Stroke: Generally, it is recommended that patients wait at least 2 to 4 weeks after a stroke before flying. However, this timeframe can vary based on the severity of the stroke and the individual's recovery progress. Since your father had a mild stroke in November 2021 and has been rehabilitating, it is crucial to assess his current health status and functional abilities.

2. Medical Clearance: Before traveling, it is advisable to obtain medical clearance from a healthcare provider who is familiar with your father's medical history. This may include a thorough evaluation of his cardiovascular health, neurological status, and overall physical condition. A travel medicine specialist can provide valuable insights and may issue a fitness-to-fly certificate.

3. Oxygen Levels: During flights, cabin pressure decreases, which can lead to lower oxygen levels in the blood. For patients with a history of stroke, heart issues, or respiratory problems, this can pose risks. It is essential to monitor your father's oxygen saturation levels, ideally keeping them above 94%. If necessary, consider arranging supplemental oxygen for the flight.

4. Risk of Deep Vein Thrombosis (DVT): Long flights increase the risk of DVT, especially in patients with limited mobility or those who have had recent surgeries. Encourage your father to move his legs frequently during the flight, perform ankle pumps, and stay hydrated. Wearing compression stockings may also help reduce the risk of blood clots.

5. Seating Arrangements: If possible, book seats in a way that allows for more space and easier movement. Business class may provide more comfort and reduce the risk of complications associated with prolonged sitting.

6. Medication Management: Ensure that your father has an adequate supply of his medications, including any necessary adjustments for time zone changes. It is generally advisable to continue taking medications at the same time relative to the local time at home, but consult with his physician for specific recommendations regarding timing adjustments.

7. Emergency Preparedness: Have a plan in place for emergencies. This includes knowing the location of medical facilities at your destination and having a list of your father's medications, allergies, and medical history readily available.

8. Travel Insurance: Consider purchasing travel insurance that covers medical emergencies, particularly given your father's health conditions. This can provide peace of mind and financial protection in case of unexpected health issues during the trip.

Conclusion
In summary, while it is possible for your father to travel by plane after a stroke, it requires careful planning and consideration of his health status. Consulting with his healthcare provider for personalized advice and obtaining medical clearance is essential. By taking the necessary precautions and being prepared, you can help ensure a safe and enjoyable trip for both you and your father. Always prioritize his health and comfort during travel, and do not hesitate to seek medical assistance if any concerns arise before or during the flight.

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