'Economy-Class Syndrome': Blood Clots and Air Travel

By Sally Squires
Washington Post Staff Writer
Sunday, January 28, 2001

The recent death of a 28-year-old British woman from a blood clot following an international flight from Australia to London underscores the problems that can result from sitting in cramped quarters during long plane trips. Emma Christofferson was a fit, active nonsmoker with no history of blood-clot disorders. Her death has sparked the announcement of a class-action suit that could target dozens of airlines.

To learn more about what's been dubbed "economy-class syndrome" and how travelers can protect themselves, we talked with experts about this growing public health problem. Here are answers to commonly asked questions.

QI've heard about economy-class syndrome. What exactly is it?

ATechnically, it's called deep vein thrombosis (DVT) -- in other words, blood clots in deep veins, usually in the legs. But doctors have dubbed it economy-class syndrome because it often strikes passengers who have spent long hours immobilized in cramped, economy-class seats. The longer they sit still without moving, the greater the likelihood of blood clots forming in their legs. That's dangerous in itself, but it can be life-threatening if part of the clot breaks loose and lodges in the lungs.

Sounds scary. Are the airlines doing anything to address this?

They're starting to address it seriously. Beginning Feb. 1, British Airways will include special inserts on blood clots with every passenger ticket jacket, according to John Lampl, spokesman for the airline. Other airlines, including EVA Air, the Taiwan-based airline that flies to North and South America, are putting together information for passengers.

How often do these blood clots occur?

Numbers are difficult to pin down because these types of blood clots are not required to be reported to medical authorities. But Barbara Alving, director of the Division of Blood Diseases and Resources at the National Heart, Lung and Blood Institute, notes that prolonged travel is now linked directly with blood clot formation. In one study, people treated at the hospital for blood clots were four times more likely to have recently gone on a long trip than those treated at the hospital for other medical problems.

Is the problem limited to plane travel?

No, long periods of inactivity in trains, buses or cars also are linked to blood clot formation, Alving says.

Do certain medical conditions heighten my risk?

Pregnancy and obesity are considered risk factors. Taking certain drugs, including oral contraceptives, estrogen and tamoxifen, can boost the odds of blood clot formation, as can smoking cigarettes. And genetics plays a role: About 5 percent of Caucasians descended from Northern Europeans have abnormal clotting that makes them more prone to forming blood clots. Of course, it ought to be self-evident that sedentary living is another major risk factor.

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