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What Is Economy Class Syndrome?
(Blood Clots)

By Dr. Peter W. Kujtan, B.Sc., M.D., Ph.D.

Article printed on page 27 in the May 29-30, 2004 issue of
The Mississauga News under the feature: Health & Wellness, Doctor's Corner.
Dr K

There has been a heightened awareness in the last decade of blood clots forming particularly in the legs after long flights in small cramped seats. There have even been deaths associated with the blood clot breaking free and traveling to the lungs where it could turn fatal. The youngest case that I am aware of is the death of a 28-year-old bride-to-be who collapsed and died after emerging from an economy class seat on a flight from Australia to London. The anecdotal reports prompted the World Health Organization into launching a study of the problem in 2001. Results have yet to be released.

Deep Vein Thrombosis (DVT) is the proper name for blood clots forming in the veins of the lower legs. Our blood is more than just a fluid carrying oxygen. It has the potential to repair and protect. Any time conditions are ripe for constriction of flow, the blood can become more sludge-like and stick to the vessel wall, initiating a small clot or thrombus. Hundreds of thousands of people develop these blood clots every year. Most of them will never know it. Many of the clots dissolve on their own and cause no problems. At times they cause leg pain and swelling. Sometimes the clot will break loose from the vessel wall and flow with the returning blood to the lungs where it lodges. This is called a pulmonary embolism. It can impede blood flow through the lungs and cause extreme breathing difficulty or death. Most people who develop detectable blood clots are treated with a blood thinner called coumadin. Persons at slightly greater risk for developing clots include those over 40 years of age, anyone who has had recent surgery, persons with cancer or a genetic blood clotting trait, and those who are pregnant or taking certain medications such as estrogen.

Controversy still remains over Economy Seat Syndrome. For obvious reasons, it has not yet been widely recognized and accepted. Those flying on full-volume long flights are most at risk. There is also a limited suggestion that the obese, the smokers and persons with varicose veins are more at risk. When seated for long periods of time, blood becomes more sludge-like. There are measures to help prevent this. The most obvious one is to eliminate small cramped seating on long distance flights. I would find it interesting to screen a plane-load of long haul economy class passengers to assess how many developed asymptomatic blood clots. Alcohol and caffeine can aid in the development of leg clots by dehydrating the traveler. Unfortunately, drinking lots of water can also be a problem. Firstly, plane tap water is generally not recommended, and secondly, there is some new data suggesting that drinking bottled water alone may also increase clotting. One alternative is to drink electrolyte replacement fluids instead such as found in some sports drinks. Long haul travelers should also ensure some form of movement or stretching every hour. Refrain from keeping your legs crossed or cramping your leg space with luggage. You may also consider wearing compression stockings.

Some prophylactic strategies are emerging. One involves the use of aspirin for those who can use it. A more interesting scenario involves the Low Molecular Weight Heparin's such as Lovenox. Lovenox is an injectable medication being used to prevent and treat blood clots in immobile patients. I can envision a role for its use in the high-risk traveler. All persons with medical conditions contemplating long flights in economy seats should seek the advice of their physician. This condition is not limited to planes but can also occur in any situation where there is prolonged immobility such as car rides. Bon voyage!

Related resources:

Economy class syndrome is the occurrence of deep vein thrombosis in air travelers, from Wikipedia, the free encyclopedia

Economy Class Syndrome

What is Deep Vein Thrombosis?

Stealth Disease

Prevention

Clots - Thromboembolism (injurious blood clots)

Risk of Air Travel Thrombosis

DVT - Deep Vein Thrombosis: Economy Class Syndrome from Dragonair.com

Thrombolytic Therapy in Emergency Medicine by Wanda L Rivera-Bou, MD, FAAEM, FACEP; Chief Editor: David FM Brown, MD. "Thrombolysis is the breaking up of a blood clot. Thrombosis is the formation or presence of a blood clot inside a blood vessel or cavity of the heart. A thrombus is a blood clot that forms inside a blood vessel or cavity of the heart. An embolus is a blood clot that moves through the bloodstream until it lodges in a narrowed vessel and blocks circulation." ~ American Heart Association.

In-Flight Fitness Guide from American Physical Therapy Association (APTA)

Reducing the Risk of "Economy Class Syndrome" from Dukehealth.org

Turns of Phrase: Economy-Class Syndrome by Michael Quinion, World Wide Words

DVT plane risk may be lower than thought from BUPA (Origin: British United Provident Association)

Economy Class Syndrome: A very real threat to long-distance travellers.

Economy class syndrome: A misnomer for a syndrome for which the evidence is, as yet, missing - editorial from eMJA (Medical Journal of Australia)

Economy Class Syndrome: Is Flying Safe?

'Economy-Class Syndrome' Not a Myth: Study by Steven Reinberg, HealthDay Reporter

The Word Spy - economy class syndrome

Can I Claim? Deep Vein Thrombosis (DVT) - Economy Class Syndrome - Travellers' Syndrome: Legal Issues.

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