Risk Factors for Venous Thromboembolism Following Prolonged Air Travel: A “Prospective” Study

Abstract

The aim of this study was to analyze patients with air-travel-related venous leg thromboembolism (VTE) concerning the occurrence of patient-related and cabin-related risk factors. Twenty-five patients, still in hospital, with deep-vein thrombosis (DVT) and/or pulmonary embolism (PE) with onset of symptoms during or after air travel were questioned according to a study protocol. There were 14 women and 11 men with an age range of 36-79 years. Flight times were 5-18 hours. All patients had DVT, and nine (36%) had PE as well. The proximal extensions of the thrombus were in tibial vein, five patients; popliteal vein, two patients; superficial femoral vein, three patients; common femoral vein, four patients; greater saphenous vein, four patients; and iliac vein, seven patients. All but two patients (92%) had one or more patient-related risk factors; the mean was three. Overweight was present in 76% of the patients; chronic heart disease in 44%; hormone medication in 40%; chronic disease, except chronic heart disease and malignancy in 32%; history of previous VTE in 28%; malignancy in 28%; smoking in 20%; recent lower limb injury in 16%; and recent surgery in 12%. Only two patients had no known patient-related risk factor. The flight travel itself does not seem to be an important risk factor in healthy individuals. However, when patient-related risk factors are superimposed, there is increasing evidence that cabin-related risk factors, such as immobilization, cramped “coach” position, insufficient fluid intake, low humidity, and hypoxia contribute to development of VTE. Improved information is required so that passengers can prepare their travel in good time. Active precautions are recommended.

Get full access to this article

View all access options for this article.

References

1. Cruickshank JN , Gorlin R , Jennett B : Air travel and thrombotic episodes: The economy class syndrome. Lancet 27:497-498, 1988.

2. Sarvesvaran R : Sudden natural deaths associated with commercial air travel. Med Sci Law 1:35-38, 1986.

3. Finch PJ , Ransford R , Hill-Smith A : Thromboembolism and air travel. Lancet ii:8618-8618, 1988.

4. Symington IS , Stack BH : Pulmonary thromboembolism after travel. Br J Dis Chest 2:138-140, 1977.

5. Eklof B , Kistner RL , Masuda EM , et al: Venous thromboembolism in association with prolonged air travel. Dermatol Surg 22:637-641, 1996.

6. Virchow R : Gesammelte Abhandlungen zur Wissenschaftlichen. Frankfurt: Meidinger, 1856.

7. Loew D , Gerlach HE , Altenkamper KH , et al: Effect of long-distance flights on edema of the lower extremities. Phlebology 13:64-67, 1998.

8. Persson AV , Davis RJ , Villavicencio JL : Deep venous thrombosis and pulmonary embolism. Surg Clin North Am 71:1195-1209, 1991.

9. Forbes CD , Johnston RV : Venous and arterial thrombosis in airline passengers. J Royal Soc Med 91:565-566, 1998.

10.

10. Mercer A , Brown JD : Venous thromboembolism associated with air travel: A report of 33 patients. Aviat Environ Med 69:154-157, 1998.

11.

11. Sugerman H , Windsor A , Bessos M , et al: Intra-abdominal pressure, sagittal abdominal diameter and obesity comorbidity. J Int Med 241:71-79, 1997.

12.

12. Ribier G , Zizka V , Cysique J , et al: Venous thromboembolic events following air travel. A study of 40 cases diagnosed in Martinique. Rev Med Interne 18:601-604, 1997.

13.

13. Landgraf H , Vanselow B , Schulte-Huermann D , et al: Economy class syndrome: Rheology, fluid balance, and lower leg edema during a simulated 12-hour long distance flight. Aviat Space Environ Med 65:930-935, 1994.

14.

14. Moyses C : Economy class syndrome. Lancet ii:1077-1077, 1988.

15.

15. Homans J : Thrombosis of the leg veins due to prolonged sitting. N Engl J Med 250:148-149, 1954.

16.

16. Wright HP , Osborn SB : Effects of posture on venous velocity, measured with 24NaCl. Br Heart J 14:325-330, 1952.

17.

17. Noddeland H , Aukland K , Nicolaysen G : Plasma colloid osmotic pressure in venous blood from the human foot in orthostasis. Acta Physiol Scand 113:447-454, 1981.

18.

18. Moyses C , Michel CC , Ledingham JGG , et al: Hemoconcentration and fibrinolytic activity in foot venous blood during sitting. Clin Sci (Lond) 68 (suppl 11): 13P-13P, 1985.

19.

19. Henriksen O : Local nervous mechanism in regulation of blood flow in human subcutaneous tissue. Acta Physiol Scand 97:385-391, 1976.

20.

20. AMA Commission on Emergency Services . Medical aspects of transportation aboard commercial aircraft. JAMA 247:1007-1011, 1982.

21.

21. Mahrer JT , Levine H , Cymerman A : Human coagulation abnormalities during acute exposure to hypobaric hypoxia. J Appl Physiol 41:702-707, 1976.

22.

22. Gertler JP , Perry L , L'Italien G , et al: Ambient oxygen pressure modulates endothelial fibrinolysis. J Vasc Surg 18:939-946, 1993.

23.

23. Cucinell SA , Pitts CM : Thrombosis at mountain altitudes. Aviat Space Environ Med 58:1109-1111, 1987.

24.

24. Simons R , Krol J : Jet lag, pulmonary embolism, and hypoxia. Lancet 348:416-416, 1996.

25.

25. Sigel B , Edelstein AL , Felix WR , et al: Compression of the deep venous system of the lower leg during inactive recumbency. Arch Surg 106:38-43, 1973.

26.

26. Lawrence D , Kakkar W : Graduated, static, external compression of the lower limb: A physiological assessment. Br J Surg 67:119-121, 1980.

27.

27. Porteous MJ , Nicholson EA , Morris LT , et al: Thigh length versus knee length stockings in the prevention of deep vein thrombosis. Br J Surg 76:296-297, 1989.

28.

28. Jeffery PC , Nicolaides AN : Graduated compression stockings in the prevention of postoperative deep vein thrombosis. Br J Surg 77:380-383, 1990.

29.

29. Schmitt HE , Mihatsch MJ : Thrombosis of the popliteal vein. Cardiovasc Intervent Radiol 15:234-239, 1992.

30.

30. Drysdale HC : Flight and risk of venous thrombosis (letter). Aviat Space Environ Med 65:957-960, 1994.

31.

31. Bellinger OK , Kirchmaier CM , Breddin HK : Objektivierung der Oedemneigung an Venenkranken und Venengesunden mittels optoelektronischer Volumetrie. VASA 33 (suppl):324-326, 1991.

32.

32. Marshall M , Dormandy JA : Oedema of long distant flights. Phlebology 2:123-124, 1987.

33.

33. Lord RSA , McGrath M , Meek AC : Predisposing factors in travellers thrombosis (abstract). XXI World Congress of the International Society for Cardiovascular Surgery, 1993.