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Coach Class/Economy Class Syndome

February 10, 2012

It is widely accepted that deep vein thrombosis (blood clot formation) or DVT in the legs is a risk of long-distance (greater than 5,000 miles) travel. The combination of immobility, dehydration, and seat pressure on veins at or below the knees increase the risk of blood clot formation. DVT is undiagnosed in 80% of cases. DVT may result in movement of the clot to the lungs (embolism) which accounts for 1 in 20 deaths in those older than 50. The incidence of DVT in the general (not hospitalized) population is unknown, but may be significant.

Risk factors for such clotting:

  • Prior history of DVT/pulmonary embolism (PE)
  • Obesity (>20% above ideal body weight)
  • Varicose veins
  • Recent surgery (with anesthesia) or physical trauma
  • Autoimmune disease
  • Type A blood type
  • Cancer/Chemotherapy
  • Clotting disorders (increased coagulability)
  • Congestive heart failure
  • Hyperlipidemia (elevated cholesterol)
  • Inflammatory bowel disease (Crohn’s/ulcerative colitis)
  • OB/GYN: Oral estrogens, Pregnancy/Post-Partum Period
  • Polycythemia/Elevated platelet counts
  • Limited mobility
  • Advanced Age

Although there are not sufficient data to routinely recommend preventive blood-thinning medications for air travel, graduated compression stockings have been shown to significantly reduce the chance of DVT in those with risk factors for excessive blood clotting.

Other highly advised recommendations:

  1. Attention to activity during the flight. Any activity that periodically (at least hourly) contracts the leg muscles (especially calves) is beneficial in keeping blood moving.
  2. Avoid dehydration by avoiding caffeine and alcohol, and by drinking liquids each hour.
  3. Consider routinely wearing gradual compression stockings (usually 15-30mm Hg pressure) for all lengthy (over 8 hours or 5,000 miles) plane flights and car trips.

IMC stocks top-quality, medical-grade stockings (ask our staff to show them).

Edward R. Rensimer, MD, FACP
Director, IMC