FAMILY MEDICINE® COLUMN

By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

STAYING ACTIVE DURING TRAVEL CAN PREVENT DEEP VEIN THROMBOSIS

Question: Recently I read that the vice president got a blood clot in his leg from traveling by airplane. I know there is such a thing as “economy class syndrome,” but I know he wasn’t traveling that way. I have a trip to Europe coming up, and this event has me concerned about getting clots. Advice?

Answer: I agree that the vice president wasn’t traveling coach class, but he is still at risk for getting a blood clot -- deep vein thrombosis or DVT -- in his leg. There are many risk factors for DVT and prolonged sitting is only one of them. The overall risk of getting a DVT is 0.1 percent in the general population. As you age, it increases to about 1 percent in people over 65. The biggest risk group is hospitalized patients, about 15 percent of whom may get DVTs.

Additional risk factors for DVTs are pregnancy, varicose veins, obesity and heart disease. Cancer, kidney disease, smoking, oral contraceptives, estrogen replacement hormones and Type A blood also increase your risk of getting a DVT.

Economy Class Syndrome is the development of blood clots in the legs during long flights. The name is a misnomer, since you can get DVT just as easily in first and business class if you sit inactively in your seat during the whole flight. And, contrary to what you might think, being in good physical shape doesn’t necessarily decrease your risk. In fact, having a DVT during flight is actually more common in young athletic travelers, especially long distance runners. The theory is that these athletes have slow heart rates and this contributes to blood pooling in the lower extremities during travel.

However, it’s not just those who are traveling in airplanes who are at risk for DVT. Similar problems can develop in people who spend a lot of time in cars as well as professional truck or bus drivers -- anybody who doesn’t get up and walk around now and then. Even people who watch TV in an easy chair for hours on end are at risk for DVT.

While a DVT itself is a concern, it can lead to another even more serious problem called a pulmonary embolism. This occurs when a piece of the blood clot in the leg breaks off and travels to the lung. It is the risk of pulmonary embolism -- which can cause sudden death -- that makes DVT a problem that is treated promptly and aggressively.

As with many medical conditions, prevention is preferable to treatment. Keep your weight down, wear support hose if you have varicose veins, and don’t smoke.

It’s also important to keep as active as possible during travel. In an airplane or even in a car, you can exercise your legs while seated. Walking is also helpful. In a car, pull over at a rest stop every hour or so and walk around for a while. On an airplane, if the pilot turns off the seat belt sign, get up and walk in the aisle -- even if it’s for just a couple of minutes. Try not to cross your legs and don’t sleep for long periods. Stay well hydrated by drinking plenty of water and avoiding alcohol.

If you are in a high risk group for DVT, I urge you to talk to your family physician. He or she can assess whether the use of special compression stockings and/or medications to decrease blood clotting would be appropriate in your case.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.