By Dr Eddy Bajrovic*
Aussie travellers have been criticised for their laid-back attitude to in-flight fashion.
Expedia surveyed more than 11,000 travellers from 22 countries in Asia-Pacific, Europe, North America, and Latin America on their flying habits.
Of the Australians surveyed, 91% of respondents (both women and men) said they dressed for comfort and ‘didn’t care how they looked’. They were happy to forego trendy tight jeans and body-hugging jackets for track pants and a jumper.
You know what? All those Aussie travellers are absolutely right to risk the odd fashion faux pas by choosing loose-fitting clothing – especially for a long international flight.
Why are DVTs dangerous?
The freedom of movement that comfortable clothing affords greatly reduces a key risk factor for deep vein thrombosis (DVT).
There’s nothing stylish about a DVT or a pulmonary embolism (PE), which are collectively known as venous thromboembolisms (VTE).
A DVT is the formation of a blood clot (called a thrombus) in the deep veins, usually the lower leg or in the thigh, or both. While it is possible for a clot to form elsewhere, such as in the arm, it’s relatively rare.
DVTs are dangerous because they can dislodge from the place where they formed within the vein and travel into the lung (pulmonary embolism), blocking its blood supply and causing shortness of breath.
Without treatment, blood clots can be fatal. VTE is the fifth leading cause of death in Australia, affecting around 52 in every 100,000 Australians.
Few travellers have no risk factors
No-one is sure why air travel holds a higher risk of blood clots than travel on land.
It may be because there is more chance to move around and stops are more frequent in cars, buses, or trains, but it could be that the lower cabin pressure and reduced oxygen level on planes plays a role, too.
Most likely, it’s the forced, prolonged immobility imposed when passengers are confined to a narrow, single seat among rows of seats, hemmed in on all sides by fellow passengers. Most of us are inclined to stay in our seats, often for long periods.
Few travellers are without any risk factors, but those at higher risk include:
- Those undertaking regular long-haul travel
- Women who are pregnant or taking hormone replacement therapy or the contraceptive pill are more susceptible.
- Anyone who has experienced a VTE previously.
- People who are obese (body mass > 30 kg/m2) or tall (over 1.9m).
- Cancer patients
- Those recently hospitalised, or had recent surgery or physical trauma
- The elderly
- Anyone with limited mobility
Prevention is better than cure
While early detection and treatment of a VTE is important, so is prevention.
Reducing the risk of a VTE is as easy as combining a few of these preventative measures:
- Exercise the lower legs regularly during the flight. An easy way is to bend your feet upward, spread the toes and hold for three seconds; then point the feet down, clench the toes and hold for three seconds. (Airlines increasingly are recognising their duty of care, offering in-flight videos on the exercises passengers can do in their seats.)
- Drink plenty of fluids – more water, less alcohol or drinks containing caffeine, both of which dehydrate.
- Ask for an aisle seat and enjoy more leg room.
- Shift position in your seat (but avoid crossing your legs).
- Walk up and down the aisles at least every 2-3 hours – moving blood is less likely to clot.
- Wear loose-fitting clothes and footwear.
- Don’t wear control underwear or stockings with tight, below-the-knee elastic. But do wear long graduated compression socks or stockings, or ‘flight socks’. These compress the calf muscles and aid the return of venous blood to the heart.
Signs you may have a VTE
Danger signs to look for include:
- Swelling of the entire leg or, more often, the calf with (or without) localised painful tenderness and redness and warmth.
- Sudden shortness of breath with rapid pulse (heart rate), chest or upper back pain and coughing up blood (which may be a life-threatening complication of lung embolism). This is a medical emergency – see a doctor immediately!
An ultrasound examination of the leg is the best way to diagnose a suspected DVT.
If a pulmonary embolism is suspected, special imaging diagnostics (computer tomography or scintigraphy) may be needed.
Deep vein thrombosis is treated with blood thinners (anticoagulants), usually for 3 to 6 months. This can be by injection or taking tablets or a combination of both.
The aim is to:
- To stop the blood clot from increasing in size, breaking loose and making its way into a lung (leading to pulmonary embolism).
- To reduce the chances of another VTE.
Although it is known as a ‘blood thinner’, aspirin is not likely to be of benefit in preventing VTE and is not recommended.
Get fitted to fly
Travellers with one or more risk factors for VTE should be assessed on an individual basis. However, those who will be travelling for more than 3 hours may be advised to wear below-the-knee compression stockings.
Stockings need to be individually fitted to ensure they don’t restrict the blood flow and thereby cause, rather than prevent, a blood clot.
To be effective, they require calf measurement and need to provide 15–30 mm Hg of pressure at the ankle. The best places to get them are at a travel clinic or a pharmacist that stocks them.
Compression stockings may not be stylish – although they do now come in fashionable black – but they will help prevent painful and potentially fatal VTE.
And, surely, that’s a comfort.
* Dr Bajrovic is Medical Director of Travelvax Australia.
See Travelvax’s tips on DVT prevention and get more advice on healthy travel for your next overseas trip by calling our travel advisory service on 1300 360 164 (toll-free from landlines). Our experienced medical professionals can also advise you on vaccinations and medication to consider during a pre-travel consultation.https://www.travelvax.com.au/holiday-traveller/travel-tips/deep-vein-thrombosis