Venous Thrombosis during Spaceflight

This correspondence describes the diagnosis and treatment of a left internal jugular vein thrombosis in an astronaut aboard the International Space Station an unprecedented case discovered during a research ultrasound exam. The astronaut remained asymptomatic, and treatment was initiated with enoxaparin, later transitioned to apixaban delivered via cargo spacecraft. Real-time telemedicine guided sonographic surveillance over three months showed progressive resolution of the thrombus. Post-landing scans confirmed organized residual clot with spontaneous flow and no need for continued anticoagulation. The case underscores the challenges of managing serious medical conditions in space, including pharmacologic constraints, tele-guided imaging, and non-evidence-based decision making. It also calls attention to physiological alterations in weightlessness that may predispose to thrombosis, urging more research ahead of long-duration missions.

This correspondence describes the diagnosis and treatment of a left internal jugular vein thrombosis in an astronaut aboard the International Space Station an unprecedented case discovered during a research ultrasound exam. The astronaut remained asymptomatic, and treatment was initiated with enoxaparin, later transitioned to apixaban delivered via cargo spacecraft. Real-time telemedicine guided sonographic surveillance over three months showed progressive resolution of the thrombus. Post-landing scans confirmed organized residual clot with spontaneous flow and no need for continued anticoagulation. The case underscores the challenges of managing serious medical conditions in space, including pharmacologic constraints, tele-guided imaging, and non-evidence-based decision making. It also calls attention to physiological alterations in weightlessness that may predispose to thrombosis, urging more research ahead of long-duration missions.