DVT
What is Thrombosis?
Thrombosis is the formation of blood clots within vessels. Clots of this type are known as thrombi. (A thrombus is a single clot.) Blood clotting is a normal process and it usually occurs as a result of injury (e.g. a cut) to prevent excessive blood loss and help the wound to heal as well. Blood does not normally clot within vessels and the development of such clots may lead to problems.Where does it occur and why?
Thrombosis can potentially occur in any blood vessel and may have fatal consequences if it obstructs the flow of blood to a vital organ (e.g. the arteries which supply blood to the heart muscle). In the context of air travel, we are concerned with thrombosis occurring in the deep veins of the lower legs. Oxygenated blood is supplied to the legs by arteries at high pressure and returns to the heart by means of veins, having had much of the oxygen removed to supply the tissues of the legs. It then passes through the lungs to be re-oxygenated before returning once again to the heart to be circulated again.The small blood vessels in the tissues of the legs and feet reduce the pressure of the blood returning in the veins. As there is a need to overcome gravity in order to return blood from the legs to the heart, the veins have non-return valves. The deep veins of the lower legs are situated in the muscles of the calf, and when compressed by muscular contraction, the non-return valves cause a pumping effect (the muscle pump) aiding the return of blood.
If the muscle pump is not working (e.g. due to immobilization), the blood flow in the veins may decrease (known as venous stasis) to the point where small thrombi may form. Most of these are too small to cause problems. However, they may sometimes enlarge significantly or link up to produce a large obstructive thrombus.
Is a DVT the same as a Pulmonary Embolism?
No. A pulmonary embolism (PE) or a lung clot may occur as a result of a DVT, if a piece of a large thrombus breaks off (It is then known as an embolus.) and is carried by the blood flow back to the heart. It is then passed through the heart into the blood vessels of the lung where it may cause obstruction of the blood flow. If, as a result, a considerably large area of the lung is damaged, the injury may be fatal. Only about 1 in every 100 DVTs results in a PE.Why is it sometimes called "Economy Class Syndrome"?
The term "Economy Class Syndrome" was first used in 1977 in a paper entitled "Pulmonary thromboembolism after travel". It is, in fact, an inaccurate term as there is no firm link between air travel in any class per se and the development of DVT. The House of Lords report recommends the use of the more appropriate term "traveler’s thrombosis".In mid 2007 the World Health Organization published the Wright Study that confirms that the primary factor involved in DVT formation is a long period of immobility. High altitude and pressurized cabins have no impact. Long periods of immobility in trains, buses and automobiles carry similar risks.
How frequent is DVT and is it becoming more common?
The normal rate of occurrence in the general population in the UK is 1 per 1,000 to 1 per 10,000 people every year, depending on age. As may be expected, since immobility and the resulting venous stasis are involved, the rate is much higher in hospital patients - particularly among those who have undergone major surgery and are unable to move around. According to the Wright Study 1 in 6,000 passengers develop DVT after periods of immobility of 4 hours or more.Immobility in a seated position is an obvious predisposition to DVT as the veins of the legs can get compressed and cause stasis. DVT is known to occur in passengers on long-distance road or rail journeys as well as those by air. The common factor in all of these is immobility rather than the environment. Pressurized cabins and high altitude of aircraft have no impact on the risk of developing a DVT.
Travel by air is now much more frequent than before. Modern aircraft feature greater travelling ranges and can carry more passengers, both of which have enhanced the convenience and affordability of air travel. This has resulted in a much greater number of long-haul air journeys. Consequently, it is expected that the total number of DVTs that occur during flight would also increase.
Greater convenience and safety of air travel also means that the elderly or disabled persons who may previously have been reluctant to travel now undertake extensive air journeys. Overall, the House of Lords report estimates an average additional risk from long-distance travel (by any means) of 0.2 per thousand people per year.
Are some people more at risk of having a DVT than others?
Yes. There are certain predisposing factors that are well known to contribute to the risk of having a DVT. These are:- Increasing age over 40 years old
- Pregnancy *
- Smoking
- Obesity
- Previously or currently suffering from malignant cancer *
- Blood disorders which lead to an increased clotting tendency *
- Heart disease or blood vessel disease *
- Personal or family history of DVT or pulmonary embolism *
- Recent surgery or major injury, especially below the waist level *
- Oestrogen hormone therapy, including oral contraception *
- Previous / recent immobilization *
- Depletion of body fluids causing increased blood viscosity
- Varicose veins
Obviously, if more than one of the above applies to you, your risk of having a DVT is further increased. If this is the case, or you have any one of the conditions marked '*', we suggest you seek the advice of your doctor before flying.
Can I do anything to reduce my risk of getting DVT while travelling by air?
Yes. As the major cause is immobility, you can do quite a lot to reduce this, and hence minimize your risk of getting DVT. Some suggestions are:- Walk around the cabin, if safe, once every 2-3 hours to break up long periods of immobility. Moving around the cabin during long flights will help to reduce the period of immobility, although this may not always be possible. Any potential health benefits must be balanced against the risk of injury if the aircraft were to experience sudden turbulence.
- Move your legs and feet for 3 or 4 minutes per hour while in your seat to get the muscle pump working and avoid stasis.
- Do some stretching exercises when waiting to use the washroom.
- Avoid wearing tight clothing around the upper thighs and body.
- Don't place hand luggage where it restricts the movement of legs and feet.
- Avoid commencing an air journey in a dehydrated state (e.g. after drinking a lot of alcohol, having a hangover or being exposed to very hot weather for long periods).
- Drinking coffee, tea and alcohol only in moderation as these are diuretics and may cause dehydration.
What are the symptoms of a DVT, and what should I do if I think I have got one?
The most common features of a DVT are:- Pain or tenderness of the calf muscles
- Swelling of the leg, especially if it is only on one side. Most people have a small degree of swelling of both feet after a long journey, but this is often due to the accumulation of water as a result of gravity and will soon recover.
- Increased skin temperature and / or redness of the leg
- Dilation of the veins right below the skin of the leg
What is Dragonair doing to prevent DVTs in passengers?
Our prime concern is the safety and health of all passengers. Although most people can undertake extensive air travel with minimal added risks, this is not the case for everyone. We aim to provide potential passengers with as much information as practicable to help you make informed decisions on your suitability to travel, and whether you should make such a decision after consulting your own doctor, and perhaps being prescribed preventive measures which may include consuming low dosage of soluble aspirin, wearing anti-embolism stockings or even taking anti-coagulant therapy for those at highest risks. There is still much to learn about DVTs and air travel. Many research projects are underway in this field, often conducted with airline funding. We are constantly updating our in-flight advice to passengers and will introduce new measures if future evidence indicates that as appropriate.For more information you may consult the following useful links:
- World Health Organization Publication: International Travel and Health Chapter 2
http://www.who.int/ith/en/ - The Aerospace Medical Association Publication: Medical Guidelines for Airline Passengers
http://www.asma.org/publications/paxguidelines.doc - American Heart Association: Economy - Class Syndrome and Deep Vein Thrombosis
http://www.americanheart.org/presenter.jhtml?identifier=3010041
