Deep vein thrombosis economy class syndrome: Difference between revisions
Rim Halaby (talk | contribs) |
Rim Halaby (talk | contribs) |
||
| Line 70: | Line 70: | ||
==Epidemiology and Demographics== | ==Epidemiology and Demographics== | ||
==Symptoms== | |||
===Deep Vein Thrombosis=== | |||
About half of people with DVT have no symptoms at all. The following are the most common symptoms of DVT that occur in the affected part of the body (usually the leg or arm): | |||
* [[Swelling]] of your leg or arm | |||
* [[Pain]] or tenderness that can not be explained | |||
* Skin that is warm to the touch | |||
* [[Redness of the skin]] | |||
===Pulmonary Embolism==== | |||
PE can be present without any symptoms of a DVT. Symptoms of a PE can include: | |||
* [[Difficulty breathing]] | |||
* Faster than normal or irregular heartbeat | |||
* [[Chest pain]] or discomfort, which usually worsens with a deep breath or [[coughing]] | |||
* [[Anxiety]] | |||
* [[Coughing up blood]] | |||
* [[Lightheadedness]], or [[fainting]] | |||
==Prevention== | ==Prevention== | ||
Revision as of 22:29, 4 June 2014
|
Deep Vein Thrombosis Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Special Scenario |
|
Trials |
|
Case Studies |
|
Deep vein thrombosis economy class syndrome On the Web |
|
Risk calculators and risk factors for Deep vein thrombosis economy class syndrome |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Economy class syndrome is the occurrence of venous thromboembolism (VTE) among air travelers.[1] VTE consists of deep vein thrombosis (DVT), pulmonary embolism (PE), or both. DVT occurs when a deep vein is partially or completely blocked by a blood clot, most commonly in the legs. The clot may break off and travel to the vessels in the lung, causing a life-threatening PE.
Historical Perspective
- VTE associated with air travel was first described in the early 1950s.[2]
- The term was first coined in the late 1980s[3] when it turned out that people who had traveled long distances by plane were at an increased risk for thrombosis, especially deep venous thrombosis and its main complication, pulmonary embolism. Although all these diseases had been recognised for a long time, the possibility of litigation against airline companies brought them into the limelight when this "syndrome" was reported.
- The WHO Research Into Global Hazards of Travel (WRIGHT) project, which was set up on 21 June 2001, is a comprehensive research programme developed by the WRIGHT group under the auspices of the World Health Organization. The project consists of a series of research studies to fill the key information gaps in available knowledge on the suspected link between air travel and venous thrombosis. The studies which cover epidemiological, clinical and physiological areas, will provide key information on VTE and air travel. The objectives of the WRIGHT (WHO Research Into Global Hazards of Travel) project were to confirm that the risk of VTE is increased by air travel and to determine the magnitude of risk, the effect of other factors on the risk and to study the effect of preventive measures on risk.[4]
Pathophysiology
The mechanism for thrombosis in travelers is probably due to a combination of immobilization, dehydration and per-existing underlying VTE risk factors. Patients with diseases that predispose them for thrombosis, such as antiphospholipid syndrome or cancer, are probably at a much greater risk. The highest risk groups include the elderly, pregnant women, those suffering serious medical conditions such as cancer and those with recent orthopedic surgery (legs or knees).
Risk Factors and Triggers
Travel Related Factors
- Most information about blood clots and long-distance travel comes from information that has been gathered about air travel. However, anyone traveling more than four hours, whether by air, car, bus, or train, can be at risk for blood clots.[5][6]
- Air flight related factors that increase the risk of VTE are:
Pr-Existing VTE Risk Factors
The risk of VTE among travellers is higher among subjects who have risk factors for VTE. Please note that the word risk factors refers to those epidemiologic and genetic variables that expose someone to a higher risk of developing venous thrombosis, whereas the word triggers refer to those factors in the patients immediate history or environment that may have lead to the occurrence of the venous thrombosis. Shown below is a list of predisposing factors to VTE.[9][10] The risk factors are classified as moderate or weak depending on how strongly they predispose for a VTE.
| Moderate risk factors | Weak risk factors |
| ❑ Chemotherapy ❑ Chronic heart failure |
❑ Advanced age ❑ Laparoscopic surgery |
Pr-Existing VTE Triggers
The risk of VTE among travellers is higher among subjects who have triggers for VTE. Please note that the word risk factors refers to those epidemiologic and genetic variables that expose someone to a higher risk of developing venous thrombosis, whereas the word triggers refer to those factors in the patients immediate history or environment that may have lead to the occurrence of the venous thrombosis. Shown below is a list of triggers of VTE.[9][10] The triggers are classified as strong, moderate, or weak depending on how strongly they predispose for a VTE.
| Strong triggers | Moderate triggers | Weak triggers |
| ❑ Bone fracture (hip or leg) ❑ Hip replacement surgery |
❑ Athroscopic knee surgery |
❑ Bed rest for more than 3 days ❑ Prolonged car or air travel |
Epidemiology and Demographics
Symptoms
Deep Vein Thrombosis
About half of people with DVT have no symptoms at all. The following are the most common symptoms of DVT that occur in the affected part of the body (usually the leg or arm):
- Swelling of your leg or arm
- Pain or tenderness that can not be explained
- Skin that is warm to the touch
- Redness of the skin
Pulmonary Embolism=
PE can be present without any symptoms of a DVT. Symptoms of a PE can include:
- Difficulty breathing
- Faster than normal or irregular heartbeat
- Chest pain or discomfort, which usually worsens with a deep breath or coughing
- Anxiety
- Coughing up blood
- Lightheadedness, or fainting
Prevention
Prevention consists of adequate hydration[1](drinking, abstaining from alcoholic beverages and caffeine), moving around and calf muscle exercises[1]. In patients with a known predisposition for thrombosis, aspirin is often prescribed, as this acts as a mild anticoagulant. Severe risk for thrombosis can prompt a physician to prescribe injections with low molecular weight heparin (LMWH), a form of prophylaxis already in common use in hospital patients.
There is clinical evidence to suggest that wearing compression socks whilst traveling also reduces the incidence of thrombosis in people on long haul flights. A randomised study in 2001 compared two sets of long haul airline passengers, one set wore MediUK mediven travel compression hosiery the others did not. The passengers were all scanned and blood tested to check for the incidence of DVT. The results showed that asymptomatic DVT occurred in 10% of the passengers who did not wear compression socks. The group wearing compression had no DVTs. The authors concluded that wearing elastic compression hosiery reduces the incidence of DVT in long haul airline passengers.[11]
Shown below is an algorithm for the indications of preventive measure for VTE among subjects undergoing a long travel.[12]
| Yes | No | ||||||||||||||||
Recommend VTE preventive measures: ❑ Calf muscle exercise ❑ Frequent ambulation ❑ To sit in an aisle seat ❑ Graduated compression stockings below the knee (pressure: 15-30 mmHg) ❑ No pharmacological VTE prophylaxis | ❑ No preventive measures are required | ||||||||||||||||
2012 American College of Chest Physicians Evidence-Based Clinical Practice Guidelines: Recommendations for Prevention of VTE in Nonsurgical Patients (DO NOT EDIT)[12]
Recommendations for Thromboprophylaxis during Long-Distance Travel (DO NOT EDIT)[12]
| Grade 2 |
| "1. For long-distance travelers at increased risk of VTE (including previous VTE, recent surgery or trauma, active malignancy, pregnancy, estrogen use, advanced age, limited mobility, severe obesity, or known thrombophilic disorder), we suggest frequent ambulation, calf muscle exercise, or sitting in an aisle seat if feasible (Level of evidence C). " |
| "2. For long-distance travelers at increased risk of VTE (including previous VTE, recent surgery or trauma, active malignancy, pregnancy, estrogen use, advanced age, limited mobility, severe obesity, or known thrombophilic disorder), we suggest use of properly fitted, below-knee GCS providing 15 to 30 mmHg of pressure at the ankle during travel (Level of evidence C). For all other long-distance travelers, we suggest against the use of GCS (Level of evidence C). " |
| "3. For long-distance travelers, we suggest against the use of aspirin or anticoagulants to prevent VTE (Level of evidence C). " |
References
- ↑ 1.0 1.1 1.2 Philbrick JT, Shumate R, Siadaty MS, Becker DM (2007). "Air travel and venous thromboembolism: a systematic review". Journal of general internal medicine : official journal of the Society for Research and Education in Primary Care Internal Medicine. 22 (1): 107–14. doi:10.1007/s11606-006-0016-0. PMID 17351849.
- ↑ HOMANS J (1954). "Thrombosis of the deep leg veins due to prolonged sitting". N Engl J Med. 250 (4): 148–9. doi:10.1056/NEJM195401282500404. PMID 13119864.
- ↑ Cruickshank JM, Gorlin R, Jennett B. Air travel and thrombotic episodes: the economy class syndrome. Lancet 1988;2(8609):497-8. PMID 2900413.
- ↑ WHO Research into global hazards of travel (WRIGHT) project. Final report of Phase I.
- ↑ CDC-Deep Vein Thrombosis (DVT) / Pulmonary Embolism (PE) — Blood Clot Forming in a Vein
- ↑ ten Wolde M, Kraaijenhagen RA, Schiereck J, Hagen PJ, Mathijssen JJ, Mac Gillavry MR; et al. (2003). "Travel and the risk of symptomatic venous thromboembolism". Thromb Haemost. 89 (3): 499–505. doi:10.1267/THRO03030499. PMID 12624634.
- ↑ 7.0 7.1 Kuipers S, Cannegieter SC, Middeldorp S, Robyn L, Büller HR, Rosendaal FR (2007). "The absolute risk of venous thrombosis after air travel: a cohort study of 8,755 employees of international organisations". PLoS Med. 4 (9): e290. doi:10.1371/journal.pmed.0040290. PMC 1989755. PMID 17896862. Retrieved 2012-04-18. Unknown parameter
|month=ignored (help) - ↑ Lapostolle F, Surget V, Borron SW, Desmaizières M, Sordelet D, Lapandry C; et al. (2001). "Severe pulmonary embolism associated with air travel". N Engl J Med. 345 (11): 779–83. doi:10.1056/NEJMoa010378. PMID 11556296.
- ↑ 9.0 9.1 Anderson FA, Spencer FA (2003). "Risk factors for venous thromboembolism". Circulation. 107 (23 Suppl 1): I9–16. doi:10.1161/01.CIR.0000078469.07362.E6. PMID 12814980.
- ↑ 10.0 10.1 Torbicki A, Perrier A, Konstantinides S, Agnelli G, Galiè N, Pruszczyk P; et al. (2008). "Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC)". Eur Heart J. 29 (18): 2276–315. doi:10.1093/eurheartj/ehn310. PMID 18757870.
- ↑ Scurr JH, Machin SJ, Bailey-King S, Mackie IJ, McDonald S, Smith PD (2001). "Frequency and prevention of symptomless deep-vein thrombosis in long-haul flights: a randomised trial". Lancet. 357 (9267): 1485–9. PMID 11377600.
- ↑ 12.0 12.1 12.2 Kahn SR, Lim W, Dunn AS, Cushman M, Dentali F, Akl EA; et al. (2012). "Prevention of VTE in nonsurgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines". Chest. 141 (2 Suppl): e195S–226S. doi:10.1378/chest.11-2296. PMC 3278052. PMID 22315261.