In our opinion, the risk assessment should also include the discussion of the impact of (subclinical) cardiovascular disease as well as the means and safety of transport abroad. This may be particularly relevant for the elderly Dutch traveler who plans to travel to destinations outside of Europe. However, before we come to a definite conclusion, it should also be noted that our study may have had significant methodological limitations like a suboptimal response rate and possibly a recall and response bias, which may limit the generalization of
our findings and raise a need for properly designed, confirmative studies. This study was financially supported by a grant of the Port of Rotterdam. The mailing of the questionnaires was made possible by an unconditional grant of GlaxoSmithKline. Ms K. Spong is acknowledged for English text editing. D. O. and P. J. J. v. G. received speaker’s fee from GlaxoSmithKline GSK126 price as well as reimbursements for attending symposia. A. C. G. states that she has no conflicts of interest to declare. “
“Relating to the article on travel and oral anticoagulation,1 we want to add an anecdote illustrating that patients with vitamin K antagonists (VKAs) are facing many problems during their
travel.2,3 In a patient, therapy of travelers’ diarrhea even deteriorated the clinical situation. A 75-year-old male patient was started on treatment with phenprocoumon 6 days ago to prevent local arterial thrombosis after plastic surgery with tissue Lepirudin transfer. The anticoagulation should last for selleck products 6 months with a target international normalized ratio (INR) range of 2 to 3. Two days after he had reached
his therapeutic INR range, he developed severe diarrhea with up to eight dejections per day. The reason for the diarrhea remains unknown. Diagnostic tests for common pathogens were negative. As the patient dehydrated, he received 2 L of crystalloid fluids per day intravenously and charcoal (5 g per day for 3 days) was administered. Diarrhea stopped within 1 day. One day after the initiation of charcoal, the INR level started to drop and reached 1.05 within 4 days (Figure 1). The patient received low molecular weight heparin during the time the INR was below 2. During this period of time, the patient had not changed his diet and no other drugs had been started or stopped. Two different mechanisms might have contributed to the fast drop in INR despite further intake of phenprocoumon. First, the diarrhea led to decreased resorption of phenprocoumon. Second, it is known that VKA could be absorbed by charcoal.4,5 We think that the latter effect may have been of higher importance, as the INR values remained on therapeutic levels for 3 days in spite of diarrhea, but dropped instantly after charcoal was administered.