ABC of Vascular Disease

Economy Class Syndrome

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1. What is Economy Class Syndrome?
Economy class syndrome is the name given to the development of a deep vein thrombosis (DVT) in the leg as a result of long distance travel.

2. How likely am I to get a DVT when travelling?
No one really knows for sure, but there is some evidence that it is commoner than was once thought.  Of the millions of people who travel long distance by air each year, a very small proportion develop a symptomatic DVT or one of its complications.  It is likely that a lot of travellers develop minor DVTs which cause no immediate or long term problems.  Anyone can get ECS but there are several things that increase the risk of getting a DVT from travelling

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Long duration of travel.

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Increasing age or previous medical history of DVT or PE, cancer, or recent major trauma or surgery.

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Reduced movement of the legs for long period of time.

3. What are the complications of DVT?
The most serious complication is a pulmonary embolus.  This is where a clot dislodges from the vein in the leg and is carried by the blood, through the right side of the heart and lodges in the artery to the lungs.  If the clot is large the person may collapse suddenly and can die.  Sudden deaths in young fit people after long flights have recently hit the news.  In principle they are preventable by simple methods.

4. Can you only get a DVT by flying economy class?
No, any situation where you are sitting still for a long period of time increases your risk of getting a DVT, it can happen on a coach or a long car journey.

5. What can I do to avoid the Economy Class Syndrome?
The primary cause of the DVT is lack of movement of the blood in the veins of the leg when sitting motionless for a long period of time combined with compression of the veins at the knee and groin when sitting upright.  The simplest way to avoid ECS is to keep active during the period of travel. This does not mean that you have to walk about all the time, just that you straighten the legs as much as possible and exercise the calves every few minutes to keep the blood from stagnating in the deep veins.  In addition it is advisable to drink plenty of water during the flight (rather than alcohol) to avoid becoming dehydrated.

6. I've seen adverts for stockings for use during travelling .. how do these help?
Research has shown that by wearing firm support socks, blood flow in the deep veins in the calf is increased and this prevents the blood from stagnating and developing clots.  It is the same reason why patients are encouraged to wear support socks before, during and after major surgery.  It is important that the socks are of the correct type (European Class 1, open-toe, below knee graduated support socks) and that they are of the correct size.  Wearing support socks also reduces the ankle swelling that some people suffer when travelling.  Socks can be obtained from a number of sources and can be purchased by mail order.

7. I have been advised to take aspirin before a long flight ... how does this help?
When taken in a low dose (75 - 150 mg) aspirin has an effect on the blood which reduces the activity of the platelets which are part of the blood clotting mechanism.  There is not much research on how effective this is in preventing Economy Class Syndrome but it is a reasonable precaution to take, particularly in the elderly traveller.  A single aspirin tablet works quickly and the effect lasts for many hours so is only necessary to take one tablet a few hours before flying. Paracetamol and other pain killers do not have the same effect.

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S.R.Dodds 2001

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