What to Worry About on Your Next Holiday Flight

Nervous flyers (myself included) have a lot of irrational things to worry about. Analyzing every funny noise in case it is an indication of imminent engine failure and being ready to assume crash position in case the pilot forgets how to land takes a lot of energy. Something that we don’t often fret about, but probably should, is the possibility of developing a life-threatening deep vein thrombosis (DVT) as a direct result of prolonged sitting in a cramped position.

Posted on | Lauren Streicher, MD | Comments ()

Nervous flyers (myself included) have a lot of irrational things to worry about. Analyzing every funny noise in case it is an indication of imminent engine failure and being ready to assume crash position in case the pilot forgets how to land takes a lot of energy. Something that we don’t often fret about, but probably should, is the possibility of developing a life-threatening deep vein thrombosis (DVT) as a direct result of prolonged sitting in a cramped position.

A deep vein thrombosis (DVT) is a blood clot that forms in a leg, thigh or pelvic vein. The danger of a DVT is that it can break off and travel to the lung, resulting in a pulmonary embolism, a serious and potentially fatal complication responsible for over 50,000 deaths in the United States each year.

Anyone can get a blood clot, but some people, especially those who develop multiple DVTs, are genetically predisposed to form blood clots more easily. And more than 80% of people that develop a DVT have at least one, and often more than one, risk factor.

Heredity aside, risk factors for DVT include age (over 50), cancer, smoking, recent surgery and obesity. In addition, excess estrogen increases the propensity to form blood clots, so pregnant women and women using hormonal contraception are also at risk. Sitting for long periods of time is problematic since immobility allows blood to pool in leg veins. It used to be that the usual person who developed a DVT was an overweight, smoking, cross-country truck driver, but the airline industry has changed that. There is even a medical term that refers to the disproportionate number of people that develop a DVT during long plane rides: "Economy class syndrome." Not every DVT causes symptoms, but if a clot restricts blood flow, there can be pain, swelling or redness in the leg. Severe chest pain, a rapid heartbeat or trouble breathing may indicate a clot has dislodged and moved to the lung.

Short of upgrading to first class, there are strategies to reduce risk. Be sure to change position frequently, don’t cross your legs, and stand up and walk around as often as possible. At a minimum, flex and extend your ankle and knees periodically. Climbing over your seatmate to get to the bathroom is also an excellent way to get the blood moving through your lower extremities.

Properly fitted below-the-knee thromboembolic compression stockings (available in pharmacies or online) are not only highly fashionable, but also dramatically reduce the risk of DVT. While taking a sleeping pill is an appealing option for the anxious flyer, spending the flight in a coma-like state increases the chance of immobility and is therefore associated with a higher rate of clot formation.

In a nutshell—keep warm, move about every hour or so, don’t smoke, wear loose clothing, and drink plenty of fluids other than caffeine or alcohol.

From one nervous flyer to another, safe travels and have a Happy Thanksgiving!

Blog written by Lauren Streicher, MD
Dr. Lauren Streicher is an Assistant Clinical Professor of Obstetrics and Gynecology at Northwestern University’s medical...