Venous Thrombosis during Spaceflight
Open accessAbstract
Venous Thrombosis during SpaceflightTo the Editor: Approximately 2 months into an International Space Station mission, obstructive left internal jugular venous thrombosis was suspected in an astronaut during an ultrasound examination that was performed as part of a vascular research study.The astronaut reported no headache or worsening of the facial plethora that is common in conditions of weightlessness.The astronaut had no personal or family history of venous thromboembolism.The physical examination revealed a prominent ipsilateral external jugular vein.Follow-up ultrasound examination performed by the astronaut, guided in real-time and interpreted by two radiologists on Earth, confirmed the presence of venous thrombosis with subacute characteristics (Fig. S1A in the Supplementary Appendix, available with the full text of this letter at NEJM.org); the contralateral internal jugular vein and the bilateral subclavian, axillary, popliteal, and femoral veins were unremarkable.Multispecialty discussions ensued, weighing the unknown risks of thrombus embolism and retrograde extension into the sinus and cerebral veins against those of anticoagulation.Twenty vials containing 300 mg of enoxaparin each were available in the pharmacy of the space station, but no anticoagulation-reversal agent was available.Treatment with enoxaparin at a dose of 1.5 mg per kilogram of body weight once daily was started; the dose was reduced to 1 mg per kilogram once daily after 33 days to extend therapy until oral apixaban could be delivered to the space station with a supply spacecraft.Protamine and prothrombin complex concentrate were also sent to the space station.Transition to apixaban at a dose of 5 mg twice daily occurred 42 days after the diagnosis of venous thrombo-1.5mg/kg 1.0 mg/kg 5.0 mg 2.5 mg
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The first occurrence of venous thrombosis during spaceflight was reported in early 2020.
“Early in 2020, the first occurrence of venous thrombosis was reported during spaceflight (Aunon-Chancellor et al., 2020).”
From Comprehensive Multi-omics Analysis Reveals Mitochondrial Stress as a Central Biological Hub for Spaceflight Impact (2020) · cites this paper as Aunon-Chancellor et al., 2020
The Abstract reports a confirmed venous thrombosis in an astronaut during an International Space Station mission, and the copy carries a 2020 copyright notice. It does not say this was the first occurrence during spaceflight or establish that it was reported early in 2020. (LLM, conf=0.84)
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Self-citationHandheld Point-of-Care Ultrasonography for Gynecology
Mathyk, B. A., Pandya, S. K., Beatty, H., Anderson, M. L., & Kohut, A. Y. (2025) · Obstetrics and Gynecology · doi:10.1097/aog.0000000000006009 · Cited by 4 · see citing works
Neck‐vein thrombosis during spaceflight
Limper, U., & Jordan, J. (2025) · British Journal of Clinical Pharmacology · doi:10.1002/bcp.70300 · Cited by 4 · see citing works
Physical exercise protects cardiovascular fitness in long-term spaceflight: what have we learned?
Zhang, Z., Xing, W., Wu, G., Zhang, X., Li, J., YingXian, L. I., & Gao, F. (2026) · Science China Life Sciences · doi:10.1007/s11427-025-3139-9 · Cited by 4 · see citing works
A Qualitative Investigation of Space Exploration Medical Evacuation Risks
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Weightlessness leads to an increase granulosa cells in the growing follicle
Kikina, A. Y., Matrosova, M. S., Gorbacheva, E. Y., Gogichaeva, K. K., Александрович, Т. К., Boyarintsev, V. V., Kotov, O. V., & Ogneva, I. V. (2024) · npj Microgravity · doi:10.1038/s41526-024-00413-4 · Cited by 4 · see citing works
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Space Ultrasound: A Proposal for Competency-based Ultrasound Training for In-flight Space Medicine.
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Surgery for interplanetary space missions
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Human Health on the Moon and Beyond and the Results of the Spaceflight for Everybody Symposium
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The Need for a Systems Approach in Spaceflight Health and Medicine
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Ultrasound imaging in spaceflight
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Spaceflight redefines ageing‐associated microbiota
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A history of the NASA operational spaceflight Surgeon:1958 – Present
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Space Medicine: Inspiring a new generation of physicians
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- Authors
- Auñón-Chancellor, S. M., Pattarini, J. M., Moll, S., & Sargsyan, A.
- Affiliations
- Louisiana State University (US)
- National Aeronautics and Space Administration (US)
- University of North Carolina at Chapel Hill (US)
- KBR (United States) (US)
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2020-01-02
- Volume
- 382
- Issue
- 1
- Pages
- 89-90
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2996799502
- Cited by
- 179
- References
- 4
- Citations by year
- 2026: 35 · 2025: 37 · 2024: 36 · 2023: 21 · 2022: 21 · 2021: 14 · 2020: 14
- FWCI
- 9.92
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
- Health Sciences › Medicine › Physiology › Spaceflight effects on biology
- Health Sciences › Medicine › Neurology › Cerebral Venous Sinus Thrombosis
- Keywords
- venous thrombosis, spaceflight, International Space Station, internal jugular vein thrombosis, astronauts, enoxaparin, apixaban, anticoagulation, anticoagulant reversal, protamine, prothrombin complex concentrate, venous thromboembolism, microgravity
- MeSH terms
- Aerospace Medicine, Anticoagulants, Drug Administration Schedule, Humans, Jugular Veins, Pyrazoles, Pyridones, Space Flight, Ultrasonography, Weightlessness, Telemedicine, Enoxaparin, Venous Thrombosis
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