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Travel and Risk for Venous Thromboembolism.+
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Was just about to post this article.
Travel more than doubles risk of blood clots: study | Lifestyle | Reuters
What does it mean for divers?
Should we be observing a "time to dive" limitation?
Will aspirin help?
Travel more than doubles risk of blood clots: study | Lifestyle | Reuters
What does it mean for divers?
Should we be observing a "time to dive" limitation?
Will aspirin help?
It's been suspected for a long time, that clots are more frequent in people who have recently done long trips (and this is one of the questions for risk factors, when one is evaluating a patient for possible pulmonary embolism).
To my knowledge, there have been no studies on best preventative measures. Getting up and walking, or using the calf "pumping" muscles in the legs at regular intervals would seem likely to be useful. Personally, I take aspirin for a day or two before long flights (although I'm not aware of any studies showing this is helpful) and I wear support stockings to minimize venous pooling.
There would be no reason to observe a "time to dive" restriction, as many VTEs take days to become symptomatic. But anyone who does long plane or car trips should be aware that asymmetric swelling of the lower limbs, or any abrupt onset chest pain or shortness of breath after a trip, should be evaluated promptly by a physician.
To my knowledge, there have been no studies on best preventative measures. Getting up and walking, or using the calf "pumping" muscles in the legs at regular intervals would seem likely to be useful. Personally, I take aspirin for a day or two before long flights (although I'm not aware of any studies showing this is helpful) and I wear support stockings to minimize venous pooling.
There would be no reason to observe a "time to dive" restriction, as many VTEs take days to become symptomatic. But anyone who does long plane or car trips should be aware that asymmetric swelling of the lower limbs, or any abrupt onset chest pain or shortness of breath after a trip, should be evaluated promptly by a physician.
Saturation
Medical Moderator
In one way, it means airlines can be sued for providing a 'hazardous' environment if you develop a DVT siting, most likely in economy. I can see the disclaimers on e-tickets coming soon.
I would hazard to guess that if the cramped econoseats become too much a nuisance, we could see innovations to make more room to stretch legs. If an entire row reclined, we can get good leg room, if even one doesn't we're stuck.
I remember when public toilet stalls trended to ever reducing sizes, until ADA required wheelchair access. ADA equipped rooms offer the best space and its not reserved for wheelchairs so most normal folks can pop in and out of there easily and enjoy the space.
Maybe the DVT scare, and worse if someone PE's, will get the airlines to innovate better economy seating.
I would hazard to guess that if the cramped econoseats become too much a nuisance, we could see innovations to make more room to stretch legs. If an entire row reclined, we can get good leg room, if even one doesn't we're stuck.
I remember when public toilet stalls trended to ever reducing sizes, until ADA required wheelchair access. ADA equipped rooms offer the best space and its not reserved for wheelchairs so most normal folks can pop in and out of there easily and enjoy the space.
Maybe the DVT scare, and worse if someone PE's, will get the airlines to innovate better economy seating.
There are persistent rumors that Delta plans to start installing these:
CozySuite
in some of their widebody aircraft in 2010.
With the current financial shape of most airlines I am not personally getting my hopes up.
OP
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Hi Dave,
Here's what I've been recommending to reduce the risk of DVT:
Deep Vein Thrombosis (DVT) and Flying
http://www.awoosh.com/DocVikingo/DVT.htm
As TSandM has indicated, a "time to dive" restriction is untenable, but do monitor for signs and symptoms of DVT after an extended period of travel in a sitting position.
Helpful?
Regards,
DocVikingo
This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual and should not be construed as such.
Here's what I've been recommending to reduce the risk of DVT:
Deep Vein Thrombosis (DVT) and Flying
http://www.awoosh.com/DocVikingo/DVT.htm
As TSandM has indicated, a "time to dive" restriction is untenable, but do monitor for signs and symptoms of DVT after an extended period of travel in a sitting position.
Helpful?
Regards,
DocVikingo
This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual and should not be construed as such.
Just another Cinderella
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So that the non med. readers are clear, people do not die from Deep Venous Thrombosis.
This term denotes the development of blood clots or thrombosis in the venous system.
The term Deep implies the veins of the deep calf, thigh and the veins of the pelvis.
Clots can often form in the superficial veins of the leg known as superficial phlebitis and while painful this is generally not dangerous.
People die from a pulmonary embolism, that is when a piece or all of the clot dislodges from the vein lining and travels to the lung by way of the right heart. The vast majority of lethal PEs come from the larger thigh veins and especially the pelvic veins. [Bigger clots from larger veins.]
Clots from the deep calf veins while a concern tend not to be lethal but 20% untreated will advance to the larger veins. Roughly 6% of patients with DVT will die from a PE. Also of those patients who have a PE about 20% will die. Unfortunately clots in deep veins often will not cause symptoms thus the reports of healthy people just dropping dead after long flights from a PE. The risk in general, however, is quite low.
As above the two biggest issues for long flights [>2hrs] are stagnation and dehydration. As divers we all should be good at staying hydrated, but get up and walk as well. Don't know of any studies that show Aspirin reducing the risk of DVT but I take it as well. Probably should start 7-10 days before [81mg] and maybe every four hours during the flight. Very little risk so why not. Graduated support stockings in flight can't hurt either especially for those trans Pacific trips.
If you have connecting flights, walk to the gate, don't use that conveyor belt thing.
Long flights are just another risk factor for DVT and possible PE so bring good health and family history on your dive vacation.
Sorry for the long post but there always seems to be a lot of confusion in the lay public about venous disease. As always the DocVikingo disclaimers apply.
This term denotes the development of blood clots or thrombosis in the venous system.
The term Deep implies the veins of the deep calf, thigh and the veins of the pelvis.
Clots can often form in the superficial veins of the leg known as superficial phlebitis and while painful this is generally not dangerous.
People die from a pulmonary embolism, that is when a piece or all of the clot dislodges from the vein lining and travels to the lung by way of the right heart. The vast majority of lethal PEs come from the larger thigh veins and especially the pelvic veins. [Bigger clots from larger veins.]
Clots from the deep calf veins while a concern tend not to be lethal but 20% untreated will advance to the larger veins. Roughly 6% of patients with DVT will die from a PE. Also of those patients who have a PE about 20% will die. Unfortunately clots in deep veins often will not cause symptoms thus the reports of healthy people just dropping dead after long flights from a PE. The risk in general, however, is quite low.
As above the two biggest issues for long flights [>2hrs] are stagnation and dehydration. As divers we all should be good at staying hydrated, but get up and walk as well. Don't know of any studies that show Aspirin reducing the risk of DVT but I take it as well. Probably should start 7-10 days before [81mg] and maybe every four hours during the flight. Very little risk so why not. Graduated support stockings in flight can't hurt either especially for those trans Pacific trips.
If you have connecting flights, walk to the gate, don't use that conveyor belt thing.
Long flights are just another risk factor for DVT and possible PE so bring good health and family history on your dive vacation.
Sorry for the long post but there always seems to be a lot of confusion in the lay public about venous disease. As always the DocVikingo disclaimers apply.
There's no particular reason to take aspirin at those close intervals, because the half-life of its effect on platelets is more than 24 hours. Risk of stomach upset or bleeding increases with the amount of aspirin and frequency of dosing.
Just another Cinderella
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I think the people who make the every four hour ASA recommendation are looking at the anti inflammatory effect [presumably at the vein wall] as well as the anti platelet effect. I would have to go back and look that up. But I do recall that none of it is clinically proven for airline DVT.
In a 14 hr flight you would be looking at a total of 325 mg, not such a large dose to cause complications.
In a 14 hr flight you would be looking at a total of 325 mg, not such a large dose to cause complications.
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Given the cost Quantas or VA charges for their sleeper seats, I don't see that as being a viable option for the vast majority of travelers. I believe RT fares to OZ are in the neighborhood of 10K.
Yes, thank you.
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