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Economy class syndrome is the occurrence of deep vein thrombosis in air travelers.[1] The term was first coined in the late 1980s[2] when it turned out that people who had traveled long distances by airplane were at an increased risk for thrombosis, especially deep venous thrombosis and its main complication, pulmonary embolism. Although all these diseases had been recognised for a long time, the possibility of litigation against airline companies brought them into the limelight when this "syndrome" was reported.
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Cause
The mechanism for thrombosis in travellers is probably due to a combination of immobilisation, dehydration and underlying factors. Additional environmental factors during air travel may possibly include reduced or sudden decrease in atmospheric pressure with consequent desaturation. [3] [1] Patients with disease that predisposes them for thrombosis, such as antiphospholipid syndrome or cancer, are probably at a much greater risk. The highest risk groups include the elderly, pregnant women, those suffering serious medical conditions such as cancer and those with recent orthopedic surgery (legs or knees).citation needed
Prevention
Prevention consists of adequate hydration[1](drinking, abstaining from alcoholic beverages and caffeine), moving around and calf muscle exercises[1]. In patients with a known predisposition for thrombosis, aspirin is often prescribed, as this acts as a mild anticoagulant. Severe risk for thrombosis can prompt a physician to prescribe injections with low molecular weight heparin (LMWH), a form of prophylaxis already in common use in hospital patients.
There is clinical evidence to suggest that wearing compression socks whilst traveling also reduces the incidence of thrombosis in people on long haul flights. A randomised study in 2001 compared two sets of long haul airline passengers over the age of 50; one set wore MediUK mediven travel compression hosiery the other did not. The passengers were all scanned and blood tested to check for the incidence of DVT. The results showed that asymptomatic DVT occurred in 10% of the passengers who did not wear compression socks, whilst the group wearing compression had no DVTs. The authors concluded that wearing elastic compression hosiery reduces the incidence of DVT in long haul airline passengers. However it is worth noting that an asymptomatic DVT incidence of 10% is much higher than expected (alternatively estimated at less than 0.25% [4]) and wearing compression stocking was also associated with symptomatic superficial thrombophlebitis in 4%. [5]
See also
References
- ^ a b c Philbrick JT, Shumate R, Siadaty MS, Becker DM (2007). "Air travel and venous thromboembolism: a systematic review". Journal of general internal medicine : official journal of the Society for Research and Education in Primary Care Internal Medicine 22 (1): 107–14. doi:. PMID 17351849.
- ^ Cruickshank JM, Gorlin R, Jennett B. Air travel and thrombotic episodes: the economy class syndrome. Lancet 1988;2(8609):497-8. PMID 2900413.
- ^ Bendz B, Rostrup M, Sevre K, Andersen TO, Sandset PM (2000). "Association between acute hypobaric hypoxia and activation of coagulation in human beings". Lancet 356 (9242): 1657–8. doi:. PMID 11089830.
- ^ Hirsh J, O'Donnell MJ (2001). "Venous thromboembolism after long flights: are airlines to blame?". Lancet 357 (9267): 1461-2. PMID 11377591.
- ^ Scurr JH, Machin SJ, Bailey-King S, Mackie IJ, McDonald S, Smith PD (2001). "Frequency and prevention of symptomless deep-vein thrombosis in long-haul flights: a randomised trial". Lancet 357 (9267): 1485–9. doi:. PMID 11377600.
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- This page was last modified on 19 August 2008, at 02:23.
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