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Wednesday, September 11, 2019

Is it Safer for you to Travel Business Class for Longer Flights? Is Economy Class Syndrome Real?

After years of conflicting and inconclusive findings by leading researchers, the World Health Organization (WHO) and The American College of Chest Physicians have provided guidelines about the health risks of prolonged periods of immobility when traveling.

Fear of "economy class syndrome" is more common than ever as airlines aim to fit more seats on planes at the expense of leg room.  Read on to learn about the definition, who is at risk, symptoms and treatment.

Remember, if you have questions related to your health, always consult your doctor or medical professional. The information presented here is informative only and is not medical advice.

What is economy class syndrome?

Economy class syndrome is a phrase coined by researchers in 1977: The formation of blood clots in veins deep within the legs -- deep vein thrombosis -- occurring during (or just after) a long airplane flight, especially in economy class where there is the least space allotted per passenger and ones legs tend especially to be immobilized due to lack of leg room.

The economy class syndrome is directly related to immobility for long periods during which blood pools in the legs, raising the risk of clot formation. The tendency to immobility is often compounded by the fasten-seat belt sign, the presence of carts in the aisles, etc.

Other suggested risk factors contributing to the syndrome include lower oxygen pressure and dehydration. Changes in oxygen pressure in the cabin may decrease the oxygen level in the blood, and air in the cabin lacks normal humidity which contributes to dehydration. The serving of coffee, tea, and alcoholic beverages, all of which are diuretics, further causes passengers to become dehydrated.

The economy class syndrome is not confined to that class on a plane. It is recommended that all persons traveling on flights, irrespective of which class they are in, drink lots of water, move their legs by walking whenever possible and by periodically flexing and extending their ankles, knees, and hips to minimize the risk of economy class syndrome. Deep vein thrombosis is potentially serious and can even have fatal consequences.

What is a Deep Venous Thrombosis (DVT)?

Quick Facts:

There are both superficial and deep veins in the limbs or extremities (arms and legs). A blood clot in the deep veins is a concern because it can cause life-threatening complications.

A blood clot (thrombus) in the deep venous system of the leg becomes dangerous if a piece of the blood clot breaks off or travels through the blood stream, the heart, and into the pulmonary arteries forming a pulmonary embolism (blood clot in the lungs). A person may or may not have signs or symptoms from a small pulmonary embolism, but a large embolism can be fatal.

The major risk factors for blood clot formation include immobility, a genetic tendency toward blood clotting, and injury to veins or adjacent tissues occurs.

Symptoms of DVT or blood clot in the leg include:

  • Pain
  • Swelling
  • Warmth
  • Tenderness
  • Redness of the leg or arm

Doctors diagnose the condition is with examination, blood tests, and ultrasound or other imaging tests.

Treatment of typically involves taking blood thinning medications (anticoagulants) unless you cannot take them, where an inferior vena cava filter is considered.

Complications of DVT include pulmonary embolism (PE) and post-phlebitic syndrome where chronic venous problems in the extremity persist.


DVT describes a blood clot (thrombosis) that forms in the deep veins located in the arm or leg. It is important to know the body's anatomy and function to understand why clots form in veins and why they can be dangerous.

  • Arteries have thin muscles within their walls to be able to withstand the pressure of the heart pumping blood to the far reaches of the body. Veins don't have a significant muscle lining, and there is nothing pumping blood back to the heart except physiology. Blood returns to the heart because the body's large muscles squeeze the veins as they contract in their normal activity of moving the body or just simply gravity. The normal activities of moving the body or raising the limb returns the blood back to the heart. Being immobile causes this blood return system to fail, and the resulting stagnated blood may clot.
  • There are two types of veins in the arm or leg; superficial veins and deep veins. Superficial veins lie just below the skin and are easily seen on the surface. Deep veins, as their name implies, are located deep within the muscles of the extremity. Blood flows from the superficial veins into the deep venous system through small veins that have one-way valves within them allowing blood to flow only in the direction of the heart when the veins are squeezed.
  • A blood clot (thrombus) in the deep venous system of the leg or arm, in itself, is not potentially fatal. It becomes potentially life threatening when a piece of the blood clot breaks off and embolizes, traveling through the circulation system through the heart, and enters into one of the pulmonary arteries and becomes lodged. This can prevent blood from flowing properly through the lung and decreasing the amount of oxygen absorbed and distributed back to the body.
  • Diagnosis and treatment of a DVT is meant to prevent pulmonary embolism.
  • Blood clots in the superficial veins do not pose as much danger to cause pulmonary emboli because the vein valves act as sieves to prevent clots from entering the deep venous system. They are usually not at risk of causing pulmonary embolism.

7 early warning signs and symptoms of DVT

The signs and symptoms of DVT are related to obstruction of blood returning to the heart and causing a backup of blood in the leg. Classic symptoms include:

  • Pain
  • Swelling
  • Warmth
  • Redness
  • Leg cramps, often starting in the calf
  • Leg pain that worsens when bending the foot
  • Bluish or whitish skin discoloration
  • You may or may not have all of these symptoms, or your may have none. The symptoms of the condition may mimic an infection or cellulitis of the arm or leg, or sciatica.

What are the risk factors for DVT?

  • Immobility, including prolonged bed rest due to illness or injury and long travel in a car or airplane
  • Pregnancy
  • Birth control pills or hormone therapy
  • Smoking
  • Cancer
  • Surgery that damages the veins in an arm or leg
  • Family history or genetic predisposition to forming blood clots
  • Obesity
There are many other risk factors that have been described, such as dehydration, but some of these have been scientifically debunked.  


Good news for airline passengers sardined in coach!

You're no more likely to develop dangerous blood clots than your first-class neighbors, according to medical guidance issued by the American College of Chest Physicians for the treatment and prevention of life-threatening clots.  Drinking cocktails instead of water during your flight isn't likely to increase your risk either, according these guidelines.

"There is no definitive evidence that dehydration, travel in economy class, and drinking alcoholic beverages on the flight are related" to the risk of pulmonary embolism or deep vein thrombosis, these guidelines say.

Most travelers who experience dangerous blockages have one or more known risk factors, including previous clotting, recent surgery, pregnancy, advanced age, active malignancy, estrogen use and limited mobility.

While the guidelines challenge the notion of "economy-class syndrome," certain space and mobility constraints do raise the risk of dangerous clots, the evidence suggests. Sitting in a window seat ups the risk, especially for obese travelers, according to the new guidelines. Also likely to be more vulnerable are very tall or short passengers and travelers who don't move during the flight.
The guidelines advise long-distance travelers against the routine use of aspirin or other blood-thinning medications to prevent clots BUT you should always ask your medical provider about your personal risk and what you should do for prevention!

Passengers with known risk factors are encouraged to book an aisle seat for long-distance travel, move around in the cabin and do calf muscle exercises. The guidelines recommend the use of compression stockings for long-distance travelers at increased risk.  For other travelers, the guidelines recommend against using the stockings, but suggest that stockings may reduce post-flight leg edema.

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A panel of medical experts developed d the new guidelines after reviewing the latest studies and evidence related to blockages of arteries in the lungs (pulmonary embolism) or blood clots in large veins, usually in the legs (deep vein thrombosis), addressing air travelers in addition to hospitalized medical patients and other nonsurgical patient groups.

Overall, the risk of a dangerous blockage for air travelers is very small. In the month following a flight, the likelihood of an incident is one in 4,600 flights, according to the report. The risk rises by 18% for each two-hour increase in the duration of travel, the guidelines said.
Travel by bus, car or train also appears to increase the risk of thrombosis, according to the guidelines.

The guidelines are endorsed by the following medical associations: the American Association for Clinical Chemistry, American College of Clinical Pharmacy, American Society of Health-System Pharmacists, American Society of Hematology, International Society of Thrombosis and Hemostasis, and the American College of Obstetrics and Gynecology (pregnancy article only).

Remember, if you have questions related to your health, always consult your doctor or medical professional. The information presented here is informative only and is not medical advice.

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