Deep Vein Thrombosis (DVT) and Flying

From an updated expanded article I wrote for Undercurrent:

“After two weeks in Australia diving the Great Barrier Reef among other activities, Emma Christofferson, a 28-year-old British woman, complained of feeling ill minutes after landing at London’s Heathrow Airport after a 20-hour flight. She then lost consciousness in the airport and died on the way to the hospital.

Christofferson, reportedly in excellent physical condition, was one of the youngest victims ever of deep vein thrombosis (DVT), sometimes called “economy-class syndrome.” First reported in 1940, when Londoners were forced to sit for hours in air-raid shelters during the Blitz, the condition begins when, after sitting for a long period, a blood clot develops in the deep veins of the calf or the thigh and works its way to the lungs or heart. Among the clinical signs are calf pain upon extension of the foot, redness and hardness at the site of the clot and swelling of the lower extremity. It becomes a dangerous condition when a piece of the clot moves through the venous circulation and lodges in the lungs, affecting circulation.

Basically, she died of sitting in the cramped seat of a jumbo jet for such a long time. Their flight home was broken only by a two-hour stop in Singapore for refueling.

While cramped legroom in an airplane contributes to the cause, simply sitting for four hours or more has been found to cut circulation in the legs by 50 percent. Dehydration, which is common on airplanes if one fails to drink adequate fluids, additionally predisposes to clot formation. These factors may account for the results of one study that showed that 18 percent of sudden deaths on airplanes are due to blood clots reaching the lungs.

Medical specialists report that the syndrome most often affects those traveling for more than 12 hours at one stretch, smokers, heavy drinkers, overweight people, those whose feet don’t reach the floor (because the seat puts more pressure on the backs of their legs) and the elderly. Individuals with a predisposition to coronary heart disease, inflammatory diseases like rheumatoid arthritis or inflammatory bowel disease, a family history of clots, pregnancy, recent surgery or a plaster cast are also at increased risk.

To help avoid DVT, stay very well hydrated; occasionally wiggle/shuffle your feet while seated; get out of your seat as often as convenient, but at least every couple of hours; and walk, stretch or do whatever you need to get circulation flowing. And wear compression support hose, available at many pharmacies and major grocery stores.

As for taking aspirin, its primary use and forte to date has been in the prevention of arterial, rather than venous clotting (e.g., DVT), although there is some research suggestive of beneficial activity within venous circulation, primarily from certain patient populations (e.g., those immobilized with hip fractures). Still, aspirin's recommendation in the prevention of traveler's thrombosis is controversial and almost certainly not as preventive as the steps outlined above. If you take aspirin, a sensible approach would be a low dose, say the 81 mg found in most baby aspirin, on a daily basis starting one week prior to the flight.”

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