The deep vein thrombosis syndrome (DVT)

The formation of blood clots in the vein of the lower limbs is known as “deep vein thrombosis”. It occurs in subjects who lead a very sedentary life and sit in the same position, as when you are flying, for lengthy periods of time. The term 'traveller's thrombosis' is to be encouraged instead of 'economy class syndrome'. More research is required to quantify the precise risk, but the risk does appear to be small and largely confined to those with recognised risk factors, which include previous episode of thrombosis, previous leg traumas, hormonal therapy (Pill), recent surgery, malignancy and pregnancy. In addition, genetic factors and haematological abnormalities can predispose to thrombosis. Such thrombophilic disorders include the factor V Leiden mutation and deficiencies of natural anticoagulants such as antithrombin, protein C and protein S. Other biological risk factors such as hyperlipidemia, hypofibrinolysis and hemorheological alterations can be involved. Venous thromboembolism (VTE) in legs and lungs is a potentially life-threatening condition. The incidence of VTE associated with air travel is still not well known, but it may have increased. Most travelers who develop symptoms do so within 24 hours after their flight takes off. Predisposing risk factors may be divided into patient-related and cabin-related factors. It is emphasized that better information and better inflight precautions can minimize these risk factors.

Recently has been shown  that low-dose heparin prophylaxis not only lowered the incidence of deep-vein thrombosis without severely augmenting the risk of bleeding, but also significantly reduced the frequency of fatal pulmonary embolism. Therefore it is suggested that the administration of low-dose subcutaneous heparin should become a routine prophylactic measure in patients with high risk of DVT.

Useful tips for preventing DVT syndrome:

For those with no known predisposing factors:

• Move around in seat and in cabin as much as practicable

• Exercise calf muscles while seated
• Drink a lot of water during the flight

• Avoid excess of alcohol and drinks containing caffeine
• Wear comfortable shoes which are not too tight around the ankle

• Observe and act on advice given in in-flight media

For those at moderate risk as above, plus:

• Take professional advice about the risks involved

• Take low dose of subcutaneous heparin before the flight, as advised by your doctor, unless contraindicated

• Take professional advice about the need to wear compression stockings
• For those at substantial risk

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