Deep vein thrombosis economy class syndrome: Difference between revisions
Rim Halaby (talk | contribs) m (Rim Halaby moved page DVT economy class syndrome to Deep vein thrombosis economy class syndrome) |
Rim Halaby (talk | contribs) |
||
| Line 13: | Line 13: | ||
There is clinical evidence to suggest that wearing [[compression stockings|compression socks]] whilst traveling also reduces the incidence of thrombosis in people on long haul flights. A randomised study in 2001 compared two sets of long haul airline passengers, one set wore MediUK mediven travel compression hosiery the others did not. The passengers were all scanned and blood tested to check for the incidence of DVT. The results showed that asymptomatic DVT occurred in 10% of the passengers who did not wear compression socks. The group wearing compression had no DVTs. The authors concluded that wearing elastic compression hosiery reduces the incidence of DVT in long haul airline passengers.<ref name="pmid11377600">{{cite journal |author=Scurr JH, Machin SJ, Bailey-King S, Mackie IJ, McDonald S, Smith PD |title=Frequency and prevention of symptomless deep-vein thrombosis in long-haul flights: a randomised trial |journal=Lancet |volume=357 |issue=9267 |pages=1485–9 |year=2001 |pmid=11377600 |doi=}}</ref> | There is clinical evidence to suggest that wearing [[compression stockings|compression socks]] whilst traveling also reduces the incidence of thrombosis in people on long haul flights. A randomised study in 2001 compared two sets of long haul airline passengers, one set wore MediUK mediven travel compression hosiery the others did not. The passengers were all scanned and blood tested to check for the incidence of DVT. The results showed that asymptomatic DVT occurred in 10% of the passengers who did not wear compression socks. The group wearing compression had no DVTs. The authors concluded that wearing elastic compression hosiery reduces the incidence of DVT in long haul airline passengers.<ref name="pmid11377600">{{cite journal |author=Scurr JH, Machin SJ, Bailey-King S, Mackie IJ, McDonald S, Smith PD |title=Frequency and prevention of symptomless deep-vein thrombosis in long-haul flights: a randomised trial |journal=Lancet |volume=357 |issue=9267 |pages=1485–9 |year=2001 |pmid=11377600 |doi=}}</ref> | ||
== | ==Prevention== | ||
Shown below is an algorithm for the indications of preventive measure for VTE among subjects undergoing a long travel.<ref name="pmid22315261">{{cite journal| author=Kahn SR, Lim W, Dunn AS, Cushman M, Dentali F, Akl EA et al.| title=Prevention of VTE in nonsurgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. | journal=Chest | year= 2012 | volume= 141 | issue= 2 Suppl | pages= e195S-226S | pmid=22315261 | doi=10.1378/chest.11-2296 | pmc=PMC3278052 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22315261 }} </ref> | |||
{{Family tree/start}} | |||
{{familytree | | | A01 | | | | A01= <div style="float: left; text-align: left; width: 20em; padding:1em;">'''Does the patient has any of the following that increase the risk of VTE?''' <br> ❑ Prior [[VTE]] episode <br>❑ Recent [[trauma]] <br> ❑ Recent [[surgery]] <br> ❑ Active [[cancer]] <br> ❑ Advanced age <br> ❑ Immobility<br> ❑ Severe [[obesity]] <br> ❑ [[Estrogen]] intake<br> ❑ [[Thrombophilia]] </div>}} | |||
{{familytree | |,|-|^|-|.| | | }} | |||
{{familytree | B01 | | B02 | | B01= Yes| B02= No}} | |||
{{familytree | |!| | | |!| | | }} | |||
{{familytree | C01 | | C02 | | C01= <div style="float: left; text-align: left; width: 15em; padding:1em;">Recommend VTE preventive measures:<br>❑ Calf muscle exercise <br> ❑ Frequent ambulation <br> ❑ To sit in an aisle seat <br> ❑ [[Graduated compression stockings]] below the knee (pressure: 15-30 mmHg)<br> ❑ No pharmacological VTE prophylaxis</div>| C02= ❑ No preventive measures are required}} | |||
{{Family tree/end}} | |||
==2012 American College of Chest Physicians Evidence-Based Clinical Practice Guidelines: Recommendations for Prevention of VTE in Nonsurgical Patients (DO NOT EDIT)<ref name="pmid22315261">{{cite journal |author=Kahn SR, Lim W, Dunn AS, ''et al.'' |title=Prevention of VTE in nonsurgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines |journal=Chest |volume=141 |issue=2 Suppl |pages=e195S–226S |year=2012 |month=February |pmid=22315261 |doi=10.1378/chest.11-2296 |url=}}</ref>== | |||
===Recommendations for Thromboprophylaxis during Long-Distance Travel (DO NOT EDIT)<ref name="pmid22315261">Kahn SR, Lim W, Dunn AS, et al. (February 2012). "Prevention of VTE in nonsurgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines". Chest 141 (2 Suppl): e195S–226S. doi:10.1378/chest.11-2296. PMID 22315261.</ref>=== | |||
{|class="wikitable" | |||
|- | |||
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACCP guidelines classification scheme#Grading Scheme Classification|Grade 2]] | |||
|- | |||
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' For long-distance travelers at increased risk of [[VTE]] (including previous VTE, recent surgery or [[trauma]], active [[malignancy]], [[pregnancy]], [[estrogen]] use, advanced age, limited mobility, severe [[obesity]], or known [[thrombophilic disorder]]), we suggest frequent ambulation, calf muscle exercise, or sitting in an aisle seat if feasible ''([[ACCP guidelines classification scheme#Level of Evidence|Level of evidence C]])''. <nowiki>"</nowiki> | |||
|- | |||
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' For long-distance travelers at increased risk of [[VTE]] (including previous VTE, recent surgery or [[trauma]], active [[malignancy]], [[pregnancy]], estrogen use, advanced age, limited mobility, severe [[obesity]], or known [[thrombophilic disorder]]), we suggest use of properly fitted, below-knee [[GCS]] providing 15 to 30 mmHg of pressure at the ankle during travel ''([[ACCP guidelines classification scheme#Level of Evidence|Level of evidence C]])''. For all other long-distance travelers, we suggest against the use of GCS ''([[ACCP guidelines classification scheme#Level of Evidence|Level of evidence C]])''. <nowiki>"</nowiki> | |||
|- | |||
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.''' For long-distance travelers, we suggest against the use of [[aspirin]] or [[anticoagulants]] to prevent VTE ''([[ACCP guidelines classification scheme#Level of Evidence|Level of evidence C]])''. <nowiki>"</nowiki> | |||
|} | |||
==References== | ==References== | ||
Revision as of 20:38, 4 June 2014
|
Deep Vein Thrombosis Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Special Scenario |
|
Trials |
|
Case Studies |
|
Deep vein thrombosis economy class syndrome On the Web |
|
Risk calculators and risk factors for Deep vein thrombosis economy class syndrome |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Economy class syndrome is the occurrence of deep vein thrombosis in air travelers.[1] The term was first coined in the late 1980s[2] when it turned out that people who had traveled long distances by plane were at an increased risk for thrombosis, especially deep venous thrombosis and its main complication, pulmonary embolism. Although all these diseases had been recognised for a long time, the possibility of litigation against airline companies brought them into the limelight when this "syndrome" was reported.
Cause
The mechanism for thrombosis in travellers is probably due to a combination of immobilisation, dehydration and underlying factors. Patients with disease that predisposes them for thrombosis, such as antiphospholipid syndrome or cancer, are probably at a much greater risk. The highest risk groups include the elderly, pregnant women, those suffering serious medical conditions such as cancer and those with recent orthopedic surgery (legs or knees).
Prevention
Prevention consists of adequate hydration[1](drinking, abstaining from alcoholic beverages and caffeine), moving around and calf muscle exercises[1]. In patients with a known predisposition for thrombosis, aspirin is often prescribed, as this acts as a mild anticoagulant. Severe risk for thrombosis can prompt a physician to prescribe injections with low molecular weight heparin (LMWH), a form of prophylaxis already in common use in hospital patients.
There is clinical evidence to suggest that wearing compression socks whilst traveling also reduces the incidence of thrombosis in people on long haul flights. A randomised study in 2001 compared two sets of long haul airline passengers, one set wore MediUK mediven travel compression hosiery the others did not. The passengers were all scanned and blood tested to check for the incidence of DVT. The results showed that asymptomatic DVT occurred in 10% of the passengers who did not wear compression socks. The group wearing compression had no DVTs. The authors concluded that wearing elastic compression hosiery reduces the incidence of DVT in long haul airline passengers.[3]
Prevention
Shown below is an algorithm for the indications of preventive measure for VTE among subjects undergoing a long travel.[4]
| Yes | No | ||||||||||||||||
Recommend VTE preventive measures: ❑ Calf muscle exercise ❑ Frequent ambulation ❑ To sit in an aisle seat ❑ Graduated compression stockings below the knee (pressure: 15-30 mmHg) ❑ No pharmacological VTE prophylaxis | ❑ No preventive measures are required | ||||||||||||||||
2012 American College of Chest Physicians Evidence-Based Clinical Practice Guidelines: Recommendations for Prevention of VTE in Nonsurgical Patients (DO NOT EDIT)[4]
Recommendations for Thromboprophylaxis during Long-Distance Travel (DO NOT EDIT)[4]
| Grade 2 |
| "1. For long-distance travelers at increased risk of VTE (including previous VTE, recent surgery or trauma, active malignancy, pregnancy, estrogen use, advanced age, limited mobility, severe obesity, or known thrombophilic disorder), we suggest frequent ambulation, calf muscle exercise, or sitting in an aisle seat if feasible (Level of evidence C). " |
| "2. For long-distance travelers at increased risk of VTE (including previous VTE, recent surgery or trauma, active malignancy, pregnancy, estrogen use, advanced age, limited mobility, severe obesity, or known thrombophilic disorder), we suggest use of properly fitted, below-knee GCS providing 15 to 30 mmHg of pressure at the ankle during travel (Level of evidence C). For all other long-distance travelers, we suggest against the use of GCS (Level of evidence C). " |
| "3. For long-distance travelers, we suggest against the use of aspirin or anticoagulants to prevent VTE (Level of evidence C). " |
References
- ↑ 1.0 1.1 1.2 Philbrick JT, Shumate R, Siadaty MS, Becker DM (2007). "Air travel and venous thromboembolism: a systematic review". Journal of general internal medicine : official journal of the Society for Research and Education in Primary Care Internal Medicine. 22 (1): 107–14. doi:10.1007/s11606-006-0016-0. PMID 17351849.
- ↑ Cruickshank JM, Gorlin R, Jennett B. Air travel and thrombotic episodes: the economy class syndrome. Lancet 1988;2(8609):497-8. PMID 2900413.
- ↑ Scurr JH, Machin SJ, Bailey-King S, Mackie IJ, McDonald S, Smith PD (2001). "Frequency and prevention of symptomless deep-vein thrombosis in long-haul flights: a randomised trial". Lancet. 357 (9267): 1485–9. PMID 11377600.
- ↑ 4.0 4.1 4.2 Kahn SR, Lim W, Dunn AS, Cushman M, Dentali F, Akl EA; et al. (2012). "Prevention of VTE in nonsurgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines". Chest. 141 (2 Suppl): e195S–226S. doi:10.1378/chest.11-2296. PMC 3278052. PMID 22315261.
External links
de:Touristenklasse-Syndrom he:תסמונת מחלקת תיירים id:Sindrom kelas ekonomi nl:Economy class-syndroom