The Dangers of Air travel – Deep Vein Thrombosis and Pulmonary Embolism
by Dr. Andrew Baddoo
Air travel is a trying ordeal at best—long lines, cramped seats, tiny bathrooms. More people are traveling, using air travel as a means to get to their destination quickly. The utilization of air travel brings forth hazards like deep vein thrombosis (DVT), and pulmonary embolism (PE) if preventable measures are not taken.
More than 300 million people travel on long-haul flights each year. An association between DVT and air travel was first reported in the early 1950s, and since then, long-haul air travel has become more common, leading to increased concerns about travel-related DVT
The term DVT and PE is sometimes referred to under the umbrella term of VTE, Venous thromboembolism . It should be known that many cases are asymptomatic and resolve spontaneously. But often VTE reoccurs and long term complications can occur.
DVT occurs when a blood clot forms in the deep veins of the leg and obstructs the flow of blood back to the heart. This can lead to swelling of the leg and pain in the calf muscle, although sometimes there are no symptoms. Pulmonary embolism occurs when blood clots leave the veins where they developed, travel through the right side of the heart, and lodge in the small or large branches of the blood vessels going to the lung (pulmonary arteries). This can cause symptoms such as chest pain, difficulty breathing, or coughing up blood. In severe cases, it may result in collapse and sudden death. Long airplane flights or multiple flights in a short period can cause deep vein thrombosis and pulmonary embolism. Any situation in which the leg is bent at the knee for prolonged periods without much active motion may lead to a reduction of
blood flow and increase the risk of blood clots. Other factors can increase this risk, such as recent surgery, taking oral contraceptives or hormone therapy, pregnancy, cancer, heart problems, and older age. Inherited genetic factors may also play a role.
•Properly fitted graduated compression stockings have been shown to be of some value.
•For people at high risk, such as those who have had a previous episode of thrombosis, low-molecular-weight heparin can be prescribed by a primary care physician and can be self-administered by injection beneath the skin just prior to
•Getting up frequently and walking in the aisle of the plane increases blood flow and may reduce the risk of clots forming but is not always practical or safe.
•The simplest preventive measure is to frequently “pump your feet” while sitting in your seat. Alternately lifting the toes and then lifting the heels increases blood flow in the calf veins and reduces the risk of forming blood clots.
•Leg exercises for air travel at rest foot pump exercises
•Older age (increasing risk after age 40)
•Obesity ( BMI > 30 kg/m2 )
•Estrogen use (hormonal contraceptives or hormone replacement therapy)
•Pregnancy and postpartum period
•Thrombophilia(such as factor V leiden mutation or antiphospholipid syndrome) or a family history of Venous thromboembolism (VTE).
•Serious medical illness (such as congestive heart failure or inflammatory bowel disease)
•Recent surgery, hospitalization, or trauma
•Central venous catherization
Please contact your physician prior to any prolong flights for recommendation regarding further preventative
)JAMA, Dec 19, 2012 Vol 308 No 2