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In 1998 the term economy class syndrome was coined to describe the association between travel and thrombosis. The potentially fatal economy-class syndrome is caused when blood clots (also known as deep venous thrombosis or DVT) develop in the deep veins of the calf and leg while sitting in cramped conditions. This may lead to the life threatening pulmonary embolism (PE).

Whilst there is a shortage of conclusive research, evidence is growing to support this link. This evidence is in the form of retrospective studies of patients who have suffered from DVT as well as theoretical explanations for the hypothesis that long-distance travel is a risk factor for DVT; however, the actual risk is poorly quantified. One of the difficulties is that whilst long journeys are strongly implicated as a strong risk, there are often no symptoms until many hours, days or weeks after leaving the plane.

This risk, however, is not limited to aeroplane travel; therefore, it may be incorrect to think of it only as an air travel related syndrome. Results of a new French case-control study indicate that journeys by car, plane, or train, lasting more than 5 hours may lead to an almost four-fold increase in the risk of DVT.

No specific clot location was associated with travel (Chest 1999; 115: 44044), although the most common DVT sites are the calf and thigh. It is important to note that whilst DVT's may develop in young individuals with no previous medical history, there are a number of recognised risk factors. These relate to:

  1. Abnormalities of the blood
  2. Injuries to the blood vessels e.g. direct trauma such as falls or sports injuries.
  3. Immobility

The risk factors can also be divided between cabin related factors and patient related factors.

The following patient-related risk factors have been identified: history of previous DVT, presence of chronic disease or malignancy, hormone therapy, recent lower limb injury and recent surgery or femoral catheterisation, chemotherapy, neurologic disease with paresis, varicose veins, and superficial vein thrombosis.In addition, 2-4 percent of the population have thrombophylic abnormalities in their blood that predispose them to DVT.

In the cabin, either immobility or blood/atmospheric factors causing dehydration may lead to an increased DVT risk. Seven cabin-related risk factors have been identified: low humidity, hypoxia, diuretic effect of alcohol, insufficient fluid intake, smoking, "coach" position, and immobilization.

It is also useful to know that soft drink contains high sugar levels, which the body has to remove in the urine, therefore, like alcohol it is also a diuretic. In travellers with patient-related risk factors, the cabin-related risk factors may increase their risks for air travel-related acute venous thromboembolism.

Active prophylaxis is generally recommended but until recently most travellers were not aware of the risk and have had to rely on common sense and or medical advice in the case of high-risk individuals.

The following general recommendations may assist with lowering one's risk of travel related DVT: Avoid drinking too much alcohol, drink water regularly, avoid taking sleeping pills while travelling, as then you are not exercising the limbs for prolonged periods. Getting up for a walk every one to two hours is also very helpful.

In addition to active prophylaxis, there are two recognised ways to decrease the risk of travel related thrombosis: medication and exercise. Effective medication includes Aspirin-which decreases platelette aggregation and is a recognised anti-coagulant.

Vascular physician, Alexanda Cohen (King's College - London, UK) recommends active exercise for the calf and legs during long travel to decrease the risk of DVTs. Whilst this is indeed very good advice and most travellers intuitively try and do this to some extent, it may not always be practical.

The following exercises if carried out correctly, may assist in decreasing the risk of developing DVT in the legs. Caution is recommended when carrying out these exercises in confined spaces. Travellers with existing risk factors are advised to consult with their Doctor prior to travelling to determine their level of risk and whether they may also require other interventions.

recommendations:

  • Avoid drinking too much alcohol or soft drinks with high sugar levels
  • Drink water regularly
  • Exercise the calf and legs for a few minutes every hour
  • Get up and walk around every one to two hours
  • Perform 5-10 slow deep breaths every hour
  • Avoid taking sleeping pills
  • Activate early when you reach your destination
  • If you are in the high-risk category, consult with your Dr prior to your travel.

Disclaimer: This information is provided for educational purposes and should not be relied upon as a substitute for Medical advice. No liability is implied or accepted for any of the information provided. If in doubt, check with your Doctor.

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