Venous Thromboembolic Complications Following Air Travel: What's the Quantitative Risk? A Literature Review (original) (raw)
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British Journal of Haematology, 2005
The current literature suggests a weak association between longdistance travel and the development of asymptomatic venous thromboembolism (VTE). Most of the data available relate to air travel and suggest that the risk is largely confined to asymptomatic calf vein thrombosis in passengers with additional risk factors for VTE, travelling for more than 8 h. The risk of both symptomatic and fatal pulmonary embolism (PE) is very small. The causal role of travel-related factors (e.g. stasis, dehydration, cramped seats and hypobaric hypoxia) is not yet proved but, given the plausible risk-free benefit, all passengers should be advised to maintain adequate hydration and exercise. There is currently no evidence for 'routine' thromboprophylaxis using stockings or drugs. In passengers with additional risk factors for VTE, thromboprophylaxis in the form of below-knee graduated compression stockings (providing 15-30 mmHg at the ankle) and/or prophylactic dose low-molecular-weight heparin may be considered. The evidence does not support the use of aspirin, which is associated with a significant rate of adverse gastrointestinal effects.
Venous Thromboembolism in the Era of Air Travel
Contemporary Cardiology, 2007
The relationship between pulmonary embolism (PE) and air travel remained questionable for a long time, despite the increasing number of passengers on long-distance flights suffering from PE. It was proposed by some authors that the observed occurrence of PE in some individuals after air travel was caused by chance alone. We recently reviewed all documented cases of PE requiting medical care upon arrival at Roissy-Charlesde-Galle, the busiest airport in France. All patients requiring medical care and transport to a hospital because of suspected PE were included, if the diagnosis of PE was confirmed. Between November 1993 and December 2000, 56 patients with confirmed PE were included. All patients had traveled at least 4000 km. The incience of PE increased with the distance traveled, and the risk of PE increased as much as 11-fold after 5000 km. The total incidence of PE reached 4.8 cases per million passengers who traveled distances longer than 7500 km. A similar incidence of PE was found in a cohort of patients arriving at Madrid airport. As the role of other predisposing (risk) factors remains uncertain, the risk of suffering PE cannot be directly determined for each passenger. We therefore believe that risk assessment with regard to air-travel-related PE should take into account the usual predisposing conditions for PE in the general population. Given the risk associated with long-duration air travel, prophylactic measures should always be considered. Behavioral and mechanical prophylaxis, including use of graduated compression stockings and minor physical activity, are currently recommended, because they are safe, easy to apply, and inexpensive. Pharmacological prophylaxis also has been discussed.
Journal of Advanced Nursing, 2005
Aim. This paper reports a systematic review whose objective was to evaluate the effectiveness of graduated compression stockings as prophylaxis for flight-related venous thrombosis, including deep vein thrombosis and superficial venous thrombosis, after air travel in the general population.Background. Despite the extended history of the use of graduated compression stockings, their application to prevent flight-related thrombosis was not explored until flight-related thrombosis was perceived as a preventable illness. Even now, their effectiveness in preventing flight-related thrombosis remains unresolved.Methods. Generic terms including stocking/s, sock/s, or hosiery/hosieries were used to search a variety of electronic databases. Based on the selection criteria, decisions regarding inclusion and exclusion of primary studies were made. Using a meta-analysis software program, relative risk for the incidence of deep vein thrombosis, superficial venous thrombosis, and intention-to-treat analysis was calculated.Results. A total of nine randomized controlled trials were included. In the treatment group, two of 1237 participants developed deep vein thrombosis in comparison with 46 of 1245 in the control group. The weighted relative risk for deep vein thrombosis was 0·08, with fixed 95% confidence interval 0·03–0·23. In the treatment group, four of 826 participants developed superficial venous thrombosis in comparison with seven of 823 in the control group. The weighted relative risk for superficial venous thrombosis was 0·67. with fixed 95% confidence interval 0·24–1·87 (non-significant difference). Using intention-to-treat analysis, the risk for participants in the treatment group was 0·53 times as great as that for those in the control group.Conclusions. This review demonstrates the effectiveness of medium compression pressure, below-knee graduated compression stockings in preventing flight-related deep vein thrombosis but not superficial venous thrombosis in low-medium- or high-risk participants.
Traveller's venous thromboembolism
Cardiovascular Surgery - CARDIOVASC SURG, 2001
Venous thromboembolism (VTE) following long distance travel has cost the lives of many travellers. A number of airlines have been successfully served with lawsuits based on their failure to warn the passengers of potential health risks of flying and especially their failure to warn against potential thromboembolism. Traveller's Venous Thromboembolism (TVTE) is not limited to air travellers and may follow road and rail travel. Most studies have focused on air travel and air travel-related VTE has been called the 'Economy Class Syndrome'. This phenomenon is by no means limited to the economy class passengers and may affect passengers in other cabin classes as well as cabin and flight crew. The incidence of TVTE is estimated to range from 0.5 to 4 per 10,000 travellers.The most common presenting symptoms are leg pain and swelling but patients may remain asymptomatic. The majority of patients develop symptoms within a week of travel. TVTE may present as deep venous thrombosis (DVT), pulmonary embolism (PE), superficial thrombophlebitis (STP) or various combinations of the three. The most common presentation of travel related DVT is femoropopliteal thrombosis and the most commonly affected leg is the left leg.The main postulated travel related risk factors are immobilisation and cramped conditions of travel, reduced humidity and hypoxia.The majority of patients, however, have multiple personal risk factors in addition to those presumed to be associated with travel. The presence of thrombophilic abnormalities as demonstrated by the authors is the most common risk factor identified in 72% of patients. Other important risk factors include female hormonal supplements, obesity, a past history or family history of VTE, history of recent trauma or surgery, and malignancy.Travel related conditions interact in an additive or even synergistic fashion with the pre-existing personal risk factors to precipitate the thrombotic event. The severity of the final outcome depends on the delicate balance between pro-coagulant and anti-coagulant factors. Clearly, there is a need to identify those travellers who have multiple risk factors. Assessment of passengers' individual risks is essential in providing appropriate advice and prophylactic measures. Airlines can help this process by informing their clients of potential risks of flying and by encouraging travellers to discuss prophylaxis with appropriate physicians especially if personal risk factors are present.This review examines the current state of knowledge regarding TVTE and proposes a set of recommendations.
2005
Correspondence: Feng-Ping Lee, Department of Nursing, Fooyin University, 151 Chin-Hsueh Road, Ta-Liao Hsiang, Kaohsuing Hsien 83142, Taiwan. E-mail: fplee@u.washington.edu HSIEH H.-F. & LEE F. -P . (2005) Journal of Advanced Nursing 51(1), 83–98 Graduated compression stockings as prophylaxis for flight-related venous thrombosis: systematic literature review Aim. This paper reports a systematic review whose objective was to evaluate the effectiveness of graduated compression stockings as prophylaxis for flight-related venous thrombosis, including deep vein thrombosis and superficial venous thrombosis, after air travel in the general population. Background. Despite the extended history of the use of graduated compression stockings, their application to prevent flight-related thrombosis was not explored until flight-related thrombosis was perceived as a preventable illness. Even now, their effectiveness in preventing flight-related thrombosis remains unresolved. Methods. Generic terms ...
International Journal of Angiology, 2008
OBJECTIVE: To systematically review the randomized controlled trials that have evaluated the efficacy of knee-length (KL) compression stockings for thromboprophylaxis in air travellers. METHOD: After an electronic database search, the randomized controlled trials that studied passengers on long-haul flights were selected and analyzed to generate summative data. RESULTS: Nine trials studying participants using KL stockings were analyzed. Forty-six of 1261 participants randomly assigned to the control group developed deep vein thrombosis (DVT), compared with two of 1237 participants (0.16%) in the KL stockings group. The weighted risk difference was-0.034, which indicated that the absolute difference was 3.4% in the incidence of DVT, in favour of KL stockings. The number needed to treat with KL stockings to avoid one case of DVT was 29.4. However, there was significant heterogeneity among trials. The RR for DVT was 0.08 in high-risk participants and 0.14 in low-to medium-risk participants. CONCLUSION: KL stockings are effective for thromboprophylaxis in air travellers at low, medium and high risk of DVT. The use of KL stockings should form an important part of air traveller education on lowering the burden of DVT. The results of the present meta-analysis can be used to advise travellers on their risk of DVT and preventive strategies.
Journal of Travel Medicine, 2006
Air travel is associated with a risk of deep vein thrombosis and pulmonary embolism, which may be fatal. The exact incidence of thromboembolism in relation to air travel is uncertain, though it has been estimated that at least 5% of all cases of deep venous thrombosis may be linked to air travel. The term "economy class syndrome" has been coined to describe the phenomenon, and this also emphasizes the role of impairment of venous circulation due to prolonged immobility in a cramped position, in the pathogenesis of the thrombosis. A number of risk factors specific to air travel are recognized, including immobility (leading to stasis in the lower limbs and hemoconcentration), compression of the popliteal vein by the edge of the seat, and dehydration. However, inherited hematological abnormalities may also predispose to thrombosis. This article reviews the pathophysiology of venous thrombosis, and gives advice on prevention as well as guidelines on the management of established thromboembolism.
Blood Advances, 2022
Background: Venous thromboembolism (VTE) is a common disease in Latin American settings. Implementation of international guidelines in Latin American settings requires additional considerations. Objective: To provide evidence-based guidelines about VTE prevention for Latin American patients, clinicians, and decision makers. Methods: We used the GRADE ADOLOPMENT method to adapt recommendations from 2 American Society of Hematology (ASH) VTE guidelines (Prevention of VTE in Surgical Patients and Prophylaxis for Medical Patients). ASH and 12 local hematology societies formed a guideline panel composed of medical professionals from 10 countries in Latin America. Panelists prioritized 20 questions relevant to the Latin American context. A knowledge synthesis team updated evidence reviews of health effects conducted for the original ASH guidelines and summarized information about factors specific to the Latin American context, that is, values and preferences, resources, accessibility, fea...