TUESDAY, Feb. 7 (HealthDay News) -- Potentially dangerous blood
clots in the legs known as deep venous thromboses (DVTs) got the
nickname "economy class syndrome" from widely publicized incidents
involving passengers on long-haul flights.
However, new guidelines from a leading physicians' group suggest
the class you sit in on a plane may not raise your DVT risk, but
your proximity to the aisle might.
Sitting in a window seat
is a risk factor for DVT, the American College of Chest
Physicians (ACCP) warn in their new advisory, regardless of whether
it's in economy or first class.
"DVT risk has nothing to do with economy class," said Dr. Gordon H. Guyatt, chair of the ACCP panel that drafted the new guidelines. "Really, the evidence is that actually where you sit isn't really an issue. It's how much you move around. And if you're in a window seat you are probably more willing to sit for long periods of time being uncomfortable because you are reluctant to make anybody else move to let you out."
The new recommendations are published in the February issue of
DVTs are blood clots that typically occur in the legs. They can
become especially dangerous if they travel through the bloodstream
to the lungs, where they can form potentially lethal pulmonary
The current guidelines, which are endorsed by a wide range of
American medical associations, are the ninth in a series of ACCP
updates on the issue. They were drafted after the panel extensively
reviewed findings from relevant studies published since the last
update in 2008.
Long-haul immobility does boost DVT risk, the experts noted. But
as the ACCP panel sifted through the evidence, they found no basis
for the notion of "economy class syndrome." Rather, folks in a
window seat might be more hesitant to get up and move around -- and
that might raise their odds for a DVT.
Still, "the first thing to say is that if you are a healthy
person you should not really worry about DVT because your risk --
even on a long-term flight -- is considerably less than one in a
thousand," said Guyatt, who is also professor in the department of
clinical epidemiology and biostatistics at McMaster University in
Hamilton, Ontario, Canada. "So these guidelines are for those who
have more than a normal risk. For those who have had a clot before,
or an abnormality of their coagulation system, or disability that
affects mobility. Or if you are obese or have active cancer."
In addition to those risk factors, the ACCP says that air
passengers who are elderly, pregnant, take supplementary estrogen
(including oral contraceptives) or recently underwent surgery
and/or trauma also face a higher-than-normal risk for DVT.
Apart from seating considerations, the guidelines also suggest
that people on flights lasting six or more hours move about
frequently and stretch their calf muscles.
Higher-risk individuals should also wear graduated compression
stockings that stretch below the knee. Guyatt said it "would be
crazy" for passengers at normal risk to wear such stockings, and
the ACCP guidelines specifically argue against their use by healthy
The guidelines also generally discourage the taking of aspirin
and/or anticoagulant medications for the specific intent of
lowering DVT risk. That said, those at very high risk are
encouraged to consult their doctors in order to weigh the pros and
cons of such drugs.
For his part, Dr. Christopher Cannon, a cardiologist at Brigham
and Women's Hospital in Boston, said the new DVT guidelines "make
obvious good sense."
"Getting up once every hour or two during a long flight and walking up and down the aisle is what you want to do," he noted. "It's not about class and the slight extra room you'll get in business. It's about sitting by the window and looking over at the guy sleeping next to you and thinking you'll wait rather than get up. That's the issue."
"I would also add that all of this would also apply to people taking long car trips," Cannon said. "I've had tons of people driving home on long car rides who have had problems with DVT. Hence the emphasis on mobility. It's all about making sure you get up or get out and move."
Find out more about DVT risk at the
U.S. National Library of Medicine.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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