Title: Relation between Air Travel and Venous Thromboembolism
Authors: Yasser M Almotairi, Mubark A Alotaibi, Khalid M almudaihish, Naqi O Alharbi, Salman M Almotairi, Jasser R Alshehri, Faleh M Alghamdi, Khalid M Alotaibi, Hussain M Aldossari, Bader M Almotairi, Sultan H Almotairi, Anwar A Almomen
DOI: https://dx.doi.org/10.18535/jmscr/v5i3.21
Abstract
Introduction
It has been, and still remains, a controversy whether air travel increases the risk of developing venous thromboembolism (VTE) or not (38). Sixty years ago, Homans (33) reported the first VTE cases related to travel. He emphasized previous where prolonged sitting was the only possible link to VTE (77). “Economy class syndrome” was first mentioned in the medical literature in 1977 (81). Since then, numerous articles have been published about the association between air travel and the development of VTE. Differing opinions, ideas, and conclusions illustrate how much this area of research continues to be debated.
References
1. Abad Rico JI, LlauPitarch JV, Rocha E. Overview of venous thromboembolism. Drugs 2010 Dec 14;70 Suppl 2:3-10.
2. Adi Y, Bayliss S, Rouse A, Taylor RS. The association between air travel and deep vein thrombosis: systematic review & meta-analysis. BMC Cardiovasc Disord 2004 May 19;4:7.
3. Anderson FA,Jr, Spencer FA. Risk factors for venous thromboembolism. Circulation 2003 Jun 17;107(23 Suppl 1):I9-16.
4. Ansari MT, Cheung BM, Qing Huang J, Eklof B, Karlberg JP. Traveler's thrombosis: a systematic review. J Travel Med 2005 May-Jun;12(3):142-154.
5. Arfvidsson B, Eklof B, Kistner RL, Masuda EM, Sato DT. Risk factors for venous thromboembolism following prolonged air travel. Coach class thrombosis. HematolOncolClin North Am 2000 Apr;14(2):391-400, ix.
6. Arya R, Barnes JA, Hossain U, Patel RK, Cohen AT. Long-haul flights and deep vein thrombosis: a significant risk only when additional factors are also present. Br J Haematol 2002 Mar;116(3):653-654.
7. Aryal KR, Al-Khaffaf H. Venous thromboembolic complications following air travel: what's the quantitative risk? A literature review. Eur J Vasc Endovasc Surg 2006 Feb;31(2):187-199.
8. Bagshaw M. Traveller's thrombosis: a review of deep vein thrombosis associated with travel. The Air Transport Medicine Committee, Aerospace Medical Associ-ation. Aviat Space Environ Med 2001 Sep;72(9):848-851.
9. Bartholomew JR, Schaffer JL, Mc Cormick GF. Air travel and venous thromboembolism: minimizing the risk. Minn Med 2011 Jun;94(6):43-49.
10. Battinelli EM, Murphy DL, Connors JM. Venous thromboembolism overview. HematolOncolClin North Am 2012 Apr;26(2):345-67, ix.
11. Beasley R, Heuser P, Masoli M. One name to rule them all, one name to find them: Lord of the Rings and 'seated immobility thromboembolism (SIT) synd-rome'. N Z Med J 2003 Jul 11;116 (1177):U498.
12. Beasley R, Raymond N, Hill S, Nowitz M, Hughes R. eThrombosis: the 21st century variant of venous thromboem-bolism associated with immobility. EurRespir J 2003 Feb;21(2):374-376.
13. Belcaro G, Geroulakos G, Nicolaides AN, Myers KA, Winford M. Venous throm-boembolism from air travel: the LONF-LIT study. Angiology 2001 Jun;52(6): 369-374.
14. Bendz B, Rostrup M, Sevre K, Andersen TO, Sandset PM. Association between acute hypobaric hypoxia and activation of coagulation in human beings. Lancet 2000 Nov 11;356(9242):1657-1658.
15. Boccalon H, Boneu B, Emmerich J, Thalamas C, Ruidavets JB. Long-haul flights do not activate hemostasis in young healthy men. J ThrombHaemost 2005 Jul;3(7):1539-1541.
16. Bradford A. The role of hypoxia and platelets in air travel-related venous thromboembolism. Curr Pharm Des 2007;13(26):2668-2672.
17. Brundrett G. Comfort and health in commercial aircraft: a literature review. J R Soc Promot Health 2001 Mar;121(1): 29-37.
18. Cannegieter SC. Travel-related throm-bosis. Best Pract Res ClinHaematol 2012 Sep;25(3):345-350.
19. Cannegieter SC, Doggen CJ, van Houwelingen HC, Rosendaal FR. Travel-related venous thrombosis: results from a large population-based case control study (MEGA study). PLoS Med 2006 Aug;3(8):e307.
20. Chandra D, Parisini E, Mozaffarian D. Meta-analysis: travel and risk for venous thromboembolism. Ann Intern Med 2009 Aug 4;151(3):180-190.
21. Cheung B, Duflou J. Pre-existing pulmonary thromboembolic disease in passengers with the "economy class syndrome". Aviat Space Environ Med 2001 Aug;72(8):747-749.
22. Choudhry VP, Upadhyay A. Deep vein thrombosis in air travellers. J Assoc Physicians India 2009 Sep;57:648-650.
23. Crosby A, Talbot NP, Harrison P, Keeling D, Robbins PA. Relation between acute hypoxia and activation of coagulation in human beings. Lancet 2003 Jun 28;361(9376):2207-2208.
24. Dimberg LA, Mundt KA, Sulsky SI, Liese BH. Deep venous thrombosis associated with corporate air travel. J Travel Med 2001 May-Jun;8(3):127-132.
25. Eklof B, Kistner RL, Masuda EM, Sonntag BV, Wong HP. Venous thromboembolism in association with prolonged air travel. DermatolSurg 1996 Jul;22(7):637-641.
26. Ferrari E, Chevallier T, Chapelier A, Baudouy M. Travel as a risk factor for venous thromboembolic disease: a case-control study. Chest 1999 Feb;115(2):440-444.
27. Gallus AS, Goghlan DC. Travel and venous thrombosis. CurrOpinPulm Med 2002 Sep;8(5):372-378.
28. Gavish I, Brenner B. Air travel and the risk of thromboembolism. Intern Emerg Med 2011 Apr;6(2):113-116.
29. Haas P, Landgraf H. Studies on travel-related thrombosis. Vasa 2008 Nov;37(4):299-310.
30. Healy B, Levin E, Perrin K, Weatherall M, Beasley R. Prolonged work- and computer-related seated immobility and risk of venous thromboembolism. J R Soc Med 2010 Nov;103(11):447-454.
31. Hertzberg SR, Roy S, Hollis G, Brieger D, Chan A, Walsh W. Acute symptomatic pulmonary embolism associated with long haul air travel to Sydney. Vasc Med 2003;8(1):21-23.
32. Hodkinson PD, Hunt BJ, Parmar K, Ernsting J. Is mild normobaric hypoxia a risk factor for venous thromboembolism? J ThrombHaemost 2003 Oct;1(10):2131-2133.
33. Homans J. Thrombosis of the deep leg veins due to prolonged sitting. N Engl J Med 1954 Jan 28;250(4):148-149.
34. Hosoi Y, Geroulakos G, Belcaro G, Sutton S. Characteristics of deep vein thrombosis associated with prolonged travel. Eur J VascEndovascSurg 2002 Sep;24(3):235-238.
35. Hughes R, Heuser T, Hill S, Ryder-Lewis S, Weatherall M, Hopkins R, et al. Recent air travel and venous thromboembolism resulting in hospital admission. Respirology 2006 Jan;11(1):75-79.
36. Hughes RJ, Hopkins RJ, Hill S, Weatherall M, Van de Water N, Nowitz M, et al. Frequency of venous thromboembolism in low to moderate risk long distance air travellers: the New Zealand Air Traveller's Thrombosis (NZATT) study. Lancet 2003 Dec 20;362(9401):2039-2044.
37. Jacobson BF, Munster M, Smith A, Burnand KG, Carter A, Abdool-Carrim AT, et al. The BEST study--a prospective study to compare business class versus economy class air travel as a cause of thrombosis. S Afr Med J 2003 Jul;93(7):522-528.
38. Johnston RV, Hudson MF, Aerospace Medical Association Air Transport Medicine Committe. Travelers' thrombosis. Aviat Space Environ Med 2014 Feb;85(2):191-194.
39. Kashyap JR, D'Cruz S, Chauhan S, Kochhar S. Venous thromboembolism associated with train travel. Med J Aust 2008 Nov 3;189(9):535-536.
40. Kelman CW, Kortt MA, Becker NG, Li Z, Mathews JD, Guest CS, et al. Deep vein thrombosis and air travel: record linkage study. BMJ 2003 Nov 8;327(7423):1072.
41. Kesteven P, Robinson B. Incidence of symptomatic thrombosis in a stable population of 650,000: travel and other risk factors. Aviat Space Environ Med 2002 Jun;73(6):593-596.
42. Kesteven PJ, Robinson BJ. Clinical risk factors for venous thrombosis associated with air travel. Aviat Space Environ Med 2001 Feb;72(2):125-128.
43. Kline JA, Putman M, Courtney DM. Fatal pulmonary embolism immediately after transatlantic air travel to the United States: less than one in a million. ThrombHaemost 2002 Feb;87(2):342.
44. Kraaijenhagen RA, Haverkamp D, Koopman MM, Prandoni P, Piovella F, Buller HR. Travel and risk of venous thrombosis. Lancet 2000 Oct 28;356(9240):1492-1493.
45. Kuipers S, Cannegieter SC, Middeldorp S, Robyn L, Buller HR, Rosendaal FR. The absolute risk of venous thrombosis after air travel: a cohort study of 8,755 employees of international organisations. PLoS Med 2007 Sep;4(9):e290.
46. Kuipers S, Schreijer AJ, Cannegieter SC, Buller HR, Rosendaal FR, Middeldorp S. Travel and venous thrombosis: a systematic review. J Intern Med 2007 Dec;262(6):615-634.
47. Kuipers S, Venemans A, Middeldorp S, Buller HR, Cannegieter SC, Rosendaal FR. The risk of venous thrombosis after air travel: contribution of clinical risk factors. Br J Haematol 2014 Jan 15.
48. Landgraf H, Vanselow B, Schulte-Huermann D, Mulmann MV, Bergau L. Economy class syndrome: rheology, fluid balance, and lower leg edema during a simulated 12-hour long distance flight. Aviat Space Environ Med 1994 Oct;65(10 Pt 1):930-935.
49. Lapostolle F, Surget V, Borron SW, Desmaizieres M, Sordelet D, Lapandry C, et al. Severe pulmonary embolism associated with air travel. N Engl J Med 2001 Sep 13;345(11):779-783.
50. Lehmann R, Suess C, Leus M, Luxembourg B, Miesbach W, Lindhoff-Last E, et al. Incidence, clinical characteristics, and long-term prognosis of travel-associated pulmonary embolism. Eur Heart J 2009 Jan;30(2):233-241.
51. Martinelli I, Taioli E, Battaglioli T, Podda GM, Passamonti SM, Pedotti P, et al. Risk of venous thromboembolism after air travel: interaction with thrombophilia and oral contraceptives. Arch Intern Med 2003 Dec 8-22;163(22):2771-2774.
52. McQuillan AD, Eikelboom JW, Baker RI. Venous thromboembolism in travellers: can we identify those at risk? Blood Coagul Fibrinolysis 2003 Oct;14(7):671-675.
53. Mercer A, Brown JD. Venous thromboembolism associated with air travel: a report of 33 patients. Aviat Space Environ Med 1998 Feb;69(2):154-157.
54. Mihailovic Z, Radnic B, Atanasijevic T, Popovic V. Pulmonary thromboembolism after air travel: two case reports, the rev-iew of literature and forensic implications. Forensic Sci Int 2012 Oct 10;222(1-3):e13-8.
55. Mittal SK, Chopra S, Calton R. Pulmonary embolism after long duration rail travel: economy class syndrome or rail coach syndrome. J Assoc Physicians India 2011 Jul;59:458-459.
56. Mittermayr M, Fries D, Gruber H, Peer S, Klingler A, Fischbach U, et al. Leg edema formation and venous blood flow velocity during a simulated long-haul flight. Thromb Res 2007;120(4):497-504.
57. Paganin F, Bourde A, Yvin JL, Genin R, Guijarro JL, Bourdin A, et al. Venous thromboembolism in passengers following a 12-h flight: a case-control study. Aviat Space Environ Med 2003 Dec;74(12):1277-1280.
58. Parkin L, Bell ML, Herbison GP, Paul C, Skegg DC. Air travel and fatal pulmonary embolism. ThrombHaemost 2006 May;95(5):807-814.
59. Parsi KA, McGrath MA, Lord RS. Traveller's venous thromboembolism. Cardiovasc Surg 2001 Apr;9(2):157-158.
60. Perez-Rodriguez E, Jimenez D, Diaz G, Perez-Walton I, Luque M, Guillen C, et al. Incidence of air travel-related pulmonary embolism at the Madrid-Barajas airport. Arch Intern Med 2003 Dec 8-22;163(22):2766-2770.
61. Pheby DF, Codling BW. Pulmonary embolism at autopsy in a normal population: implications for air travel fatalities. Aviat Space Environ Med 2002 Dec;73(12):1208-1214.
62. Philbrick JT, Shumate R, Siadaty MS, Becker DM. Air travel and venous thromboembolism: a systematic review. J Gen Intern Med 2007 Jan;22(1):107-114.
63. Rosendaal FR. Venous thrombosis: the role of genes, environment, and behavior. Hematology Am SocHematolEduc Program 2005:1-12.
64. Samama MM. An epidemiologic study of risk factors for deep vein thrombosis in medical outpatients: the Sirius study. Arch Intern Med 2000 Dec 11-25;160(22):3415-3420.
65. Sandor T. Travel thrombosis: Pathomech-anisms and clinical aspects. Pathophys-iology 2008 Dec;15(4):243-252.
66. Sarvesvaran R. Sudden natural deaths associated with commercial air travel. Med Sci Law 1986 Jan;26(1):35-38.
67. Schobersberger W, Fries D, Mittermayr M, Innerhofer P, Sumann G, Schobersberger B, et al. Changes of biochemical markers and functional tests for clot formation during long-haul flights. Thromb Res 2002 Oct 1;108(1):19-24.
68. Schobersberger W, Mittermayr M, Innerhofer P, Sumann G, Schobersberger B, Klingler A, et al. Coagulation changes and edema formation during long-distance bus travel. Blood Coagul Fibrinolysis 2004 Jul;15(5):419-425.
69. Schobersberger W, Schobersberger B, Mittermayr M, Fries D, Streif W. Air travel, hypobaric hypoxia, and prothrombotic changes. JAMA 2006 Nov 15;296(19):2313-4; author reply 2314-5.
70. Schobersberger W, Toff WD, Eklof B, Fraedrich G, Gunga HC, Haas S, et al. Traveller's thrombosis: international consensus statement. Vasa 2008 Nov;37(4):311-317.
71. Schreijer AJ, Cannegieter SC, Caramella M, Meijers JC, Krediet RT, Simons RM, et al. Fluid loss does not explain coagulation activation during air travel. ThrombHaemost 2008 Jun;99(6):1053-1059.
72. Schreijer AJ, Cannegieter SC, Meijers JC, Middeldorp S, Buller HR, Rosendaal FR. Activation of coagulation system during air travel: a crossover study. Lancet 2006 Mar 11;367(9513):832-838.
73. Schwarz T, Langenberg K, Oettler W, Halbritter K, Beyer J, Siegert G, et al. Deep vein and isolated calf muscle vein thrombosis following long-haul flights: pilot study. Blood Coagul Fibrinolysis 2002 Dec;13(8):755-757.
74. Schwarz T, Siegert G, Oettler W, Halbritter K, Beyer J, Frommhold R, et al. Venous thrombosis after long-haul flights. Arch Intern Med 2003 Dec 8-22;163(22):2759-2764.
75. Scurr JH, Machin SJ, Bailey-King S, Mackie IJ, McDonald S, Smith PD. Frequency and prevention of symptomless deep-vein thrombosis in long-haul flights: a randomised trial. Lancet 2001 May 12;357(9267):1485-1489.
76. Simons R, Krol J. Jet leg, pulmonary embolism, and hypoxia. Lancet 1996 Aug 10;348(9024):416.
77. Simpson K. Shelter Deaths from Pulmonary Embolism. Lancet 1940;236( 6120):744.
78. Siniarski A, Wypasek E, Fijorek K, Gajos G, Undas A. Association between thrombophilia and seated immobility venous thromboembolism. Blood Coagul Fibrinolysis 2014 Mar;25(2):135-141.
79. Stricker H, Colucci G, Godio M, Mossi G, Mombelli G. The influence of a prolonged sitting position on the biochemical markers of coagulation activation in healthy subjects: evidence of reduced thrombin generation. J ThrombHaemost 2003 Feb;1(2):380-381.
80. Suadicani P, Hannerz H, Bach E, Gyntelberg F. Jobs encompassing prolonged sitting in cramped positions and risk of venous thromboembolism: cohort study. JRSM Short Rep 2012 Feb;3(2):8.
81. Symington IS, Stack BH. Pulmonary thromboembolism after travel. Br J Dis Chest 1977 Apr;71(2):138-140.
82. ten Wolde M, Kraaijenhagen RA, Schiereck J, Hagen PJ, Mathijssen JJ, Mac Gillavry MR, et al. Travel and the risk of symptomatic venous thromboe-mbolism. ThrombHaemost 2003 Mar;89(3):499-505.
83. Toff WD, Jones CI, Ford I, Pearse RJ, Watson HG, Watt SJ, et al. Effect of hypobaric hypoxia, simulating conditions during long-haul air travel, on coagulation, fibrinolysis, platelet function, and endothelial activation. JAMA 2006 May 17;295(19):2251-2261.
84. Trujillo-Santos AJ, Jimenez-Puente A, Perea-Milla E. Association between long travel and venous thromboembolic disease: a systematic review and meta-analysis of case-control studies. Ann Hematol 2008 Feb;87(2):79-86.
85. Tsoran I, Saharov G, Brenner B, Barron M, Valdes V, de la Roca Toda M, et al. Prolonged travel and venous thromboembolism findings from the RIETE registry. Thromb Res 2010 Oct;126(4):287-291.
86. Walsh C, Lauer MS, Huang PL, Page RL. Bowl-game pulmonary embolism. N Engl J Med 1986 May 15;314(20):1324.
87. Watson HG, Baglin TP. Guidelines on travel-related venous thrombosis. Br J Haematol 2011 Jan;152(1):31-34.
88. White RH. The epidemiology of venous thromboembolism. Circulation 2003 Jun 17;107(23 Suppl 1):I4-8.