Gavish I. and Brenner B. Internal and Emergency Medicine 2011;6(2):113-116
As the holiday season approaches, thoughts turn to the joys and challenges of long-haul flights to exotic destinations. More than 300 million people take one or more long-haul flights every year, either for pleasure or for business. For many, the trip is exciting and for most, the journey is tiring. A few travellers, however, will experience adverse events during or soon after the flight.
The risk for deep vein thrombosis, which can be life-threatening, during or soon after a long-haul flight is estimated at 3-12%. The real incidence of the problem is difficult to evaluate since there is no consensus about the diagnostic tests or limitation of time after landing connected to the VTE complication. The contributing factors were identified as: venous stasis as a result of sitting for prolonged periods in cramped condition, hypoxia in the airplane cabin, and dehydration. Especially at risk ate those individuals over 40 years of age, women, especially those who use oral contraceptives, and anyone with varicose veins in the lower limbs, obesity and genetic thrombophilia.
The main preventative measures are avoiding dehydration and prolonged sitting. The latter is difficult, but the former can be addressed quite easily, by ensuring good hydration prior to departure and by regular intake of fluid during the flight. For high-risk individuals, additional steps might include wearing elastic stockings and use of a blood thinning agent. Of all the available steps that can be taken, though, attention to good hydration is probably the easiest and most effective.
Almost two billion people use commercial aircraft annually. Long-haul flights are taken by over 300 million people. A serious complication of long-distance travel (or prolonged time of flight) is thromboembolism. The real incidence of the problem is difficult to evaluate since there is no consensus about the diagnostic tests or limitation of time after landing connected to the VTE complication. A direct relation between VTE incidence and long-distance flights has been documented. The risk for DVT is 3-12% in a long-haul flight. The pathophysiologic changes that increase VTE risk at flight are stasis (sitting in crowded condition), hypoxia in the airplane cabin, and dehydration. Individual risk factors for air travel-related VTE include age over 40 years, gender (female), women who use oral contraceptives, varicose veins in lower limbs, obesity and genetic thrombophilia. Prevention measures include environmental protection such as keeping the pressure inside the airplane cabinet in hypobaric condition, avoiding dehydration and prolonged sitting. For individuals at increased risk, venous blood stasis can be reduced by wearing elastic stockings and prophylactic use of low-molecular-weight heparin.
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