Economy Class DVT Syndrome: True or False? Prevention & Risk Factors

Economy class’ DVT syndrome is nothing buy a myth . Sitting in a cramped budget seat in a plane’s economy class on a long-haul flight increases the risk of deep vein thrombosis (DVT). Right?

Wrong, the United Kingdom’s national health provider says, finally debunking the long-held medical myth.

For quite some time now, some frequent flyers have tried to avoid economy class seats in a bid to avoid the supposed “economy-class syndrome” — in which a passenger in an economy class seat was supposedly to be more prone to developing deep vein thrombosis, or a blood clot in the deep veins of the thighs or pelvis.

Deep vein thrombosis often leads to complications like a piece of clot breaking off, traveling to the lungs and blocking one of the lung vessels, in what is known as a life-threatening pulmonary embolism.

But the existence of this so-called “economy-class syndrome” has always been controversial, has never been proven—and has now been debunked.

Writing in its website, the NHS presented new evidence-based guidelines produced by the American College of Chest Physicians (ACCP) on the risk of DVT after long-haul flights and the potentially fatal lung clots that can follow.

Published in the February issue of the medical journal CHEST, the guidelines are extensive, running over hundreds of pages, the NHS said.

The guidelines detail the risk factors for DVT, measures to diagnose and prevent DVT — as well as recommendations for travelers to reduce their risk of DVT.

To come up with the guidelines, the ACCP conducted a review of existing risk factors for developing DVT on long-haul flights.

Risk factors
First, the reviewers concluded that it was generally unlikely to develop DVT or pulmonary embolism from a long-distance flight.

Second, they took note of the some factors that increased the risk for developing deep blood clots, and lastly, they noted that the passengers who do end up developing a DVT/PE after long-distance travel have one or more of the risk factors

These are:
• previous DVT or pulmonary embolism or known “thrombophilic disorder”
• recent surgery or trauma
• immobility
• advanced age
• cancer
• estrogen use, including oral contraceptives
• pregnancy
• sitting in a window seat
• obesity

According to the reviewers, the limited mobility of long-distance travelers who sit in a window seat was the factor responsible for an increased risk of DVT—not whether they were in an economy or business-class seat. Remaining immobile for long periods does increase the risk for DVT, the American chest physician-reviewers concluded.

They also noted that while “symptomatic DVT/PE [pulmonary embolism] is rare in passengers who have returned from long flights,” people who take flights longer than eight to ten hours have a higher risk of developing deep blood clots and pulmonary embolisms.

No evidence for economy class DVT
But the review did not find any definitive evidence to support the theory that dehydration, alcohol intake and sitting in an economy seat—rather than in a seat in the business class—increased the risk of DVT or pulmonary embolism during a long-distance flight.

“On this basis, they conclude that traveling in economy class does not increase the risk of developing a blood clot, even during long-distance travel,” the NHS said.

If you’re a businessperson who has no choice but to go on frequent, long business trips. Or, if you have to take a flight longer than six hours and have one of the risk factors for DVT, here’s what you can do to prevent it:
• Sit in an aisle seat if possible, as this will make it more likely that you will get up and move around in flight
• Stretch your calf muscles.
• Stand up and take a walk frequently during the flight.
• Wear below-the-knee compression stockings that are “graduated”—this means they are designed to put pressure on the lower legs, feet and ankles to increase the flow of blood and make it harder for a clot to form.

Note that the guidelines DON’T advise:

• Taking a blood-thinning aspirin or anticoagulant therapy to prevent DVT or pulmonary embolism. The chest physicians say only those who have a particularly high risk for DVT should consider this.
• Wearing compression stockings, especially if you are a long-distance travelers who isn’t at risk of DVT.

Experiencing a DVT and pulmonary embolism together is venous thromboembolism (VTE), a life-threatening condition. Each year more than 25,000 people in the U.K. die from VTE contracted in hospital—25 times more than the people who die from the feared methicillin-resistant Staphylococcus aureus (MRSA).

In hospitals, patients often have to lie down for long periods after an operation. VTE frequently occurs in situations like this. But in recent years the NHS and U.K.’s Department of Health have implemented measures to reduce the rates of hospital-developed VTE, including giving patients a VTE risk assessment when being booked into hospital.

Note that anyone can develop a DVT, but there are certain known risks:
• previous venous thromboembolism
• family history of thrombosis
• being overweight or obese
• pregnancy
• medical conditions such as cancer and heart failure
• advanced age
• inactivity (for example after an operation or on a long-haul flight)

Blood clots happen when blood platelets aggregate or when a complex cascade of reactions that leads to the coagulation of blood is set off, or when both happen.

Symptoms of a deep blood clot may include persistent leg swelling, leg pain or tenderness, chest pain, or sudden shortness of breath or difficulty breathing. If you who think you’re experiencing symptoms of a blood clot, seek immediate medical attention.

On Feb. 7, the ACCP released a press release debunking the economy class syndrome myth. The release had a title, American College of Chest Physicians: New DVT Guidelines: No Evidence to Support ‘Economy Class Syndrome’: Oral Contraceptives, Sitting in a Window Seat, Advanced Age, and Pregnancy Increase DVT Risk in Long-distance Travelers.


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