Thrombosis/embolism

 

 

Incidence

 

Annual incidence 1 per 1000

 

Risk factors include:

 

Prolonged immobility in a sitting position

Personal or family history of DVT or pulmonary embolism

Surgery, recent pelvic or lower limb injury, or prolonged immobilization

History of malignancy (cancer)

Pregnancy or postpartum (the first 6 weeks after childbirth)

Estrogen therapy (oral contraceptives, hormone replacement therapy, tamoxifen)

Coagulation (blood clotting) disorder predisposing to thrombosis

Over 40 years of age

Congestive heart failure or recent myocardial infarction (heart attack)

Dehydration (due to diarrhea or other conditions)

 

Prevention

 

Wear comfortable, loose-fitting clothing when possible. Avoid clothing that binds at the knees (such as socks/stockings with strong elastic tops) or at the waist (such as pantyhose).

When flying, wear graded compression stockings that exert 20-30 mmHg at the ankle level (such as support stockings).

 When practical and safe, walk around in the aircraft cabin frequently during the trip.

Stand up at your seat and stretch your arms and legs periodically. Many airlines now provide video presentations on stretching exercises during long flights.

Exercise your leg and calf muscles frequently by flexing and extending your feet.

Avoid crossing your legs since this may decrease blood circulation to your legs.

Use a footrest when possible to reduce the pressure on the back of your thighs from the seat. Alternatively, elevate your feet on a briefcase, small bag, or pillow.

When possible, book an exit row seat to allow more space for leg stretches or an aisle seat to allow easier access for walking.

During transit stops disembark and walk around.

Drink plenty of water to prevent dehydration.

Avoid alcohol and coffee, both of which contribute to dehydration.

Avoid sleeping pills during a flight.

 

Symptoms-leg thrombosis

 

Leg pain, ache or disconfort

Leg swelling

Increased warmth in the leg

Leg discoloration  (red)

Joint pain

 

Symptoms-subclavian thrombosis

 

Swelling of the arm

Axillary tenderness

 

Symptoms- pulmonary embolism

 

Chest pain

Palpitations

Shortness of breath

Dyspnea

 

Treatment

 

Anticoagulant

 

References

 

1.                  DuPont HL, Steffen R.  Textbook of Travel Medicine and Health.  First Edition.  BC Decker Inc, Hamilton, London.  1997

 

2.                  Jong EC, McMullen R. The Travel and Tropical Medicine Manual .Third  Edition.  Saunders, Philadelphia, Pensylvania. 2003

 

3.         Mendis S,Yach D, Alwan A. Air Travel and venous thromboembolism.

            Bulletin of the World Health Organisation 2002,80 (5)

 

3.                  Website: www.travax.com

 

 

 

 

Nicole Denommé

Ottawa Hospital-General Campus

Fax: (613) 737-8009

e-mail: ndenomme@ottawahospital.on.ca