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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).
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.
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.
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:
Abnormalities of the blood
to the blood vessels e.g. direct trauma such as falls or sports
risk factors can also be divided between cabin related factors and
patient related factors.
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.
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,
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.
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.
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.
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.
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.
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.
drinking too much alcohol or soft drinks with high sugar levels
Drink water regularly
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.
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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