Frequent flyer screen

This is to screen for the risk of developing deep vein thrombosis (clots in deep veins) in those who are frequent flyers, develop foot and ankle swelling on flights or have varicose veins at present or in the in the past. The screen includes:

Ultrasound duplex screening scan for venous incompetence and deep vein thrombosis
D-Dimer test for sub-clinical thrombosis
Occlusion plethysmography testing to look for obstruction to the outflow of venous blood from the legs
Assessment for the need for compression stockings and measured compression hosiery fitted for travel

All air travel carries the risk of deep vein thrombosis or DVT, which is the formation of clots in the deeper veins in legs, regardless of frequency or duration of the flight. Long haul flights (over 6 hours) and multiple short haul flights (3 or more flights in a month of less than 6 hours duration) increase that risk. Being overweight, having varicose veins, a previous history of clots in the veins, vein clots or pulmonary embolism (PE) in a close family relative, recent pregnancy or within 3 months of childbirth, being on birth control pills or hormone replacement therapy for menopause, cancer and recent major hip, limb, or pelvic surgery all add to this risk. Following the COVID pandemic, this risk has likely increased worldwide as exposure to COVID can cause the inner lining of the blood vessels to stay inflamed for many months, with an increased risk of clot formation.

Developing a DVT can lead to these clots breaking off and travelling to the heart and lungs, a condition known as pulmonary embolism (PE) – a serious complication that can be life threatening. Our Frequent Flyer screen is designed to help identify the risks of these complications early and grade each individual’s risk. This allows us to make recommendations to take preventative measures to reduce the risk and fly safely.

Who is this screen for?

If you are a frequent flyer (6 or more long-haul flights a year or 3 or more short haul flights a month or combinations thereof), or develop swelling of the legs and feet after a flight, or are at a higher risk of deep vein thrombosis from having varicose veins, have a family history of vein clots or pulmonary embolism (PE) in a close relative, have had recent surgery or treatment for cancer, a recent pregnancy or childbirth or hormone therapy or are overweight and are due to fly – this screening program is for you.

What tests does this screen contain?

Nurse assessment

For CAPRINI DVT risk scoring, measurement for Class 1 compression stockings for flights, body composition measurements, BP, risk factor and medication record.

Urine test

For blood cells, sugar and protein.

Blood tests

Full blood count – low haemoglobin levels affect the ability of the circulation to carry oxygen; High white cell counts can signify infection.
Glycated haemoglobin or HbA1C – a measure of average blood sugar control over 3 months.
Kidney function – poor kidney function can cause limb swelling from a variety of circulation-related mechanisms.
Liver function – blood clotting is affected by how well the liver functions.
Lipid (cholesterol) profile – to assess circulation health.
D-Dimer – this detects whether small clots are being formed (and broken down) inside the circulation.
Clotting profile with Prothrombin time and thromboplastin time – to assess how well the clotting mechanism is functioning.

ECG

Ultrasound Duplex scan for Chronic venous insufficiency and DVT

This is to assess for any pre-existing venous insufficiency, valve disease or old clots in the veins.

Occlusion plethysmography

A non-invasive simple screening test for restrictions to venous blood returning to the heart.

Consultation with a senior specialist vascular surgeon

To discuss results and develop a plan to reduce the risk of DVT and PE on flights.

You will be measured and fitted for suitable Class 1 calf length compression stockings (Flight socks) and provided to you as a part of this package.

This screening package DOES NOT include a Thrombophilia screen, which involves blood tests including a genetic test for inherited or acquired abnormalities in your blood clotting mechanisms (and carries additional cost). These are not routinely done but are recommended if you have a family history (close relative) of DVT, pulmonary embolism or other clots, or have had unexplained clots in your circulation in the past. Thrombophilia testing is part of our Frequent Flyer Plus screen.

How do I prepare for this screen and how long does it take?

If you have booked this screen, you should have received instructions on what to expect on-email or phone. If not, please call the clinic at least 1 day before the screen on +65 64720503 during working hours to confirm the instructions.
The screen is conducted over 2 days. Plan about 4 hours in the clinic on the first day and about 1 hour on the second day.
You will need to come in the morning on Day 1 having fasted (without having had anything to eat) for at least 6 hours. You may have clear non-sugary drinks, black coffee or black tea.
Please DO NOT take your diabetic medication, if prescribed for you, on the morning of Day 1, but you should bring the medication with you. You must, however, take any other medication you take for blood pressure or blood thinners etc with water as normal.
Wear comfortable loose clothing and shoes for the first day. A T-shirt and shorts or track bottoms are ideal.

What can I expect on the screening days?

On Day 1 of the screen, you will first be registered for the screening.
You will then be asked to provide a mid-stream urine sample and have your blood tests as you are fasting.
You may then go and have breakfast and return to clinic where you will have the nurse assessment and can have your diabetic medication as well.
All remaining tests will be done after that and should usually be completed on Day 1. Day 1 may need up to 4 hours to complete.
On Day 2 (which can be scheduled to your convenience but would be at least 3 days after Day 1 to allow for all test results to come back in), you will see the specialist vascular surgeon for a consultation and discussion. Day 2 may need up to 1 hour to complete. Please eat and take medications as normal on Day 2.

What if my screening detects a problem?

We will give you a detailed report and recommendations in writing to take away.
If screening results suggest you need further investigations or treatment, you will also be given a note for you to show your family doctor to make a formal referral to us. Further treatments or tests may not be covered by insurance if there is not a formal referral.
Your screening results and reports are NOT shared by us with your doctor or any third party including your insurers or employers. Sharing your report results with other doctors, insurers or employers is for you to do as you deem fit but is recommended.

How often is a Frequent Flyer screen needed?

This comprehensive screen is needed as a one-off screen only, to ensure that any underlying disease that may lead to DVT or PE is detected early. Any further follow up and treatment, if required, will depend on what the screening tests show.

you are covered

We are on the panel with most insurers in Singapore and with many international insurers; We also offer convenient options for self-paying patients.