Quick Facts on Venous Thromboembolism (VTE)

VTE is related to two life-threatening conditions – Deep Venous Thrombosis (DVT) and Pulmonary Embolism (PE).

DVT is the clotting or thrombosis of blood in deep veins of the body, usually the deep leg veins in the calf or thigh. This can cause pain and swelling in the leg, but more importantly can lead to the complication of pulmonary embolus, where a portion of the thrombus breaks off and travels to the lungs, where it can block blood flow to the lungs. This can be potentially fatal.

Risk factors include:

• Prolonged immobility eg. postoperatively, or with prolonged travel
• Increasing age
• Previous DVT’s
• Family history of thromboembol ism
• Overweight
• Smoking
• Medications eg. oral contraceptive pill or hormone replacement therapy
• Pregnancy
• Medical conditions such as cancer and heart failure

The increased risk of DVT with flying is predominantly related to prolonged immobility, especially in a restricted space. For this reason DVT has been known as Traveller’s Thrombosis or Economy Class Syndrome. The risk of DVT with flying is increased with dehydration, which can be exacerbated by consumption of alcohol and caffeine.

Best prevention methods include:

• Mobilizing in the cabin and leg exercises
• Increased fluid intake
• Minimise alcohol and caffeine intake
• Compression stockings, especially with other risks factors
• No definite evidence or benefit with low dose aspirin

DVT causes pain, redness and swelling of the lower leg and the diagnosis is confirmed by Doppler ultrasound scan of the lower leg. Pulmonary embolus causes chest pain and shortness of breath and diagnosis is by a chest x-ray, lung scan and a confirmatory blood test. Treatment is with Anticoagulant medications to prevent further blood clotting and is supplemented by the use of compression stockings.

Flight attendants are generally a population that is young, healthy, and mobile, and are therefore not at increased risk of DVT and PE, but they need to be aware of risk factors, especially dehydration, alcohol, caffiene and smoking.

Pilots need to maintain their health in order to meet the standards required for annual medical examinations and are therefore reasonably healthy. They are less immobile and less cramped than passengers. Pilots have been found to have a lower incidence of DVT and PE compared to the general population, and to frequent travellers. Studies have shown that the overall risk of venous thromboembolism is not increased amongst pilots.

Again, awareness of risks factors and minimisation of risk is advisable.

This notable article was written by Dr. Ralph Joyce, Group Medical Director, Specialist Family Medicine & Aviation Medicine. For an appointment with Dr. Ralph, please call the Jumeirah Medical branch on 04 349 4880.