Travel Advice - Deep Vein Thrombosis

[ The article that follows presents information about a medical condition that may result from extended air travel. You are responsible for your health care and should ask your doctor for professional information about any medical issues. Do not rely on this article as a substitute for advice from a professional health care practitioner.]

In mid-September 2004, the American College of Chest Physicians issued new guidelines on Thrombolytic Therapy and Deep Vein Thrombosis (DVT). The press release was publicized in the travel sections of many major newspapers. We thought you would be interested in a more detailed discussion of DVT, what it is, what you should know about DVT prevention.

Deep Vein Thrombosis is a condition in which a blood clot (a thrombus) forms in the inside of a “deep vein” (one of the veins surrounded by powerful muscles that pumps blood back to the heart).

• In DVT, the thrombus can grow in size and impact circulation or break-off and cause a pulmonary embolism, resulting in serious illness and, possibly, death.
• DVT occurs most commonly in the lower limbs

DVT has many causes, some related to genetics and other related to environmental conditions such as:

• Inactivity
• Pregnancy (extending to immediately following delivery),
• Recent surgery
• Recent injury
• Cancer
• And, possibly, the use of oral contraceptives.

The Chair of the panel that created the American College of Chest Physicians’ report, Dr. Jack Hirsh said, “There is much speculation about the occurrence and treatment of deep vein thrombosis or ‘economy class syndrome,’ that can occur in patients spending several hours on a plane. Although prevention is often focused on at-risk patients…we strongly advise all patients traveling of flights of more than six hours to take the necessary precautions to prevent thrombosis.”

Specific recommendations in the report included:

• For flights longer than six hours, patients, with or without risk for DVT should avoid constrictive clothing around the lower extremities and waist
• Avoid dehydration
• Engage in frequent calf muscle stretching
• Patients at risk for VTE (venous thromboembolism) should consider using a graduated compression stocking or receive a dose of low molecular-weight heparin (LMWH).

In addition consider the following:

•  Wear loose fitting, comfortable clothes and shoes.
• Take a walk around the airport while you are waiting for your international flight (after all, you can defer sitting until you board the plane).
• Once onboard the plane, do not sit in one position for extended periods.
• Do in-seat exercises to keep your blood flowing.
  •  Wiggle your ankles and toes.
    •  Bring travel socks or slippers for the flight or remove your shoes to have room to wiggle you toes.
  • Stretch your calf muscles by extending your legs and pointing your toes at your head
  • Tighten, and then relax your gluts (buttocks).
  • Flex your thighs Wiggle your torso by rotating your shoulders.
• Avoid dehydration.
  • Drink plenty of fluids (not alcohol) and consider packing a bottle of water in your carry-on.
• During the flight get up and take a short walk around the plane every hour or two.
• Do not sit with your legs crossed

What are the symptoms of DVT?

DVT may produce no obvious symptoms; however, if you experience a sharp pain in the thigh, cough-up blood, have chest pain, or encounter difficulty breathing, contact medical assistance on an emergency basis.

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