Risk of Venous Thromboembolism Among Individuals who Frequently Travel by Flight for Work
Abstract
Many research studies have found that venous thromboembolism is common among frequent travellers in all form mainly air travel. Few Indian studies in acute care settings had also mentioned travel history as an important element. Nowadays a section of corporate employees are frequent flyers in India. Hence, we conducted a pilot project to assess and analyze the risk category among these employees. A snowball sampling was used as a sampling technique. The data collection method was done using a google survey link. An anonymous questionnaire link with a unique code of four digit inserted by the participants, had been circulated among the identified study participants. Out of the total 30 respondents, 13 (43.3%) were at high risk, 8(26.7%) at medium risk and 9 (30%) at low-risk categories of venous thromboembolism development. Pre-existing risk factors and post-travel observation (within 8 weeks of flight travel) were recorded and analysed with SPSS 22 version. Family history was significantly associated with risk category of the employees with chi-square (χ²) value of 22.46 (p<0.05). For high-risk category employees, the venous thromboembolism risk was increased by 44 times (OR 44, 95% CI 3.4-573.4) and for medium-risk category employees 13 times (OR 13.3, 95% CI 1.07-166.4) with the history of infectious disease exposure. Overall presence of certain pre-existing clinical parameters (like heart disease, congenital heart disease, varicose veins, pregnancy, exposure to infectious disease) were significantly associated with a chi-square (χ²) value of 6.09 (p<0.05). Further knowledge level and practice level of these frequent corporate flyers had a statistically significant association with their risk category. This paved the way to develop holistic need-based guidelines covering all relevant key aspects of venous thromboembolism including the head-neck-foot exercise to prevent venous thromboembolism while flying.
Keywords:
Indian corporate employees, frequent flyers, venous thromboembolism (VTE)
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References
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Brar, R., & Saha, P. K. (2020). In-flight announcements and messages on safety leaflets may be useful to reduce the risk of deep vein thrombosis (DVT) during long distance air travel. Travel Medicine and Infectious Disease, 33, 101515. https://doi.org/10.1016/j.tmaid.2019.101515
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Kelman, C. W. (2003). Deep vein thrombosis and air travel: record linkage study. BMJ, 327(7423), 1072–0. https://doi.org/10.1136/bmj.327.7423.1072
Koh, C. H. (2021). Commercial Air Travel for Passengers With Cardiovascular Disease: Recommendations for Common Conditions. Current Problems in Cardiology, 46(3), 100768. https://doi.org/10.1016/j.cpcardiol.2020.100768
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Kuipers, S., Venemans‐Jellema, A., Cannegieter, S. C., van Haften, M., Middeldorp, S., Büller, H. R., & Rosendaal, F. R. (2014). The incidence of venous thromboembolism in commercial airline pilots: a cohort study of 2630 pilots. Journal of Thrombosis and Haemostasis, 12(8), 1260–1265. https://doi.org/10.1111/jth.12627
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Mwansa, H., Zghouzi, M., & Barnes, G. D. (2023). Unprovoked Venous Thromboembolism. Medical Clinics of North America, 107(5), 861–882. https://doi.org/10.1016/j.mcna.2023.05.006
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Ram, S., Ram, H. S., Neuhof, B., Shlezinger, R., Rosenthal, Y. S., Chodick, G., & Yogev, Y. (2022). Does Air Travel During Pregnancy Increase the Risk of Venous Thrombosis? SSRN Electronic Journal. https://doi.org/10.2139/ssrn.4005131
Ram, S., Shalev-Ram, H., Neuhof, B., Shlezinger, R., Shalev-Rosental, Y., Chodick, G., & Yogev, Y. (2023). Air travel during pregnancy and the risk of venous thrombosis. American Journal of Obstetrics & Gynecology MFM, 5(1), 100751. https://doi.org/10.1016/j.ajogmf.2022.100751
Righini, M., & Suhl, J. (2023). Update on venous thromboembolism in pregnancy. JMV-Journal de Médecine Vasculaire, 48(3–4), 97–99. https://doi.org/10.1016/J.JDMV.2023.10.003
Sarkar, P., Srivastava, S., Das, J., & Kumar, A. (2023). Narrative Review on Prevalence of Venous Thromboembolism and Public Awareness in India. Malaysian Journal of Nursing, 15(01), 173–186. https://doi.org/10.31674/mjn.2023.v15i01.019
Scurr, J. H., Machin, S. J., Bailey-King, S., Mackie, I. J., McDonald, S., & Smith, P. D. C. (2001). Frequency and prevention of symptomless deep-vein thrombosis in long-haul flights: a randomised trial. The Lancet, 357(9267), 1485–1489. https://doi.org/10.1016/S0140-6736(00)04645-6
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Aryal, K. R., & Al-khaffaf, H. (2006). Venous Thromboembolic Complications Following Air Travel: What’s the Quantitative Risk? A Literature Review. European Journal of Vascular and Endovascular Surgery, 31(2), 187–199. https://doi.org/10.1016/j.ejvs.2005.08.025
Bergmann, J. F., Lloret-Linares, C., Rami, A., Cohen, A. T., Garay, R. P., Kakkar, A. K., Goldhaber, S. Z., Deslandes, B., Tapson, V. F., Anderson, F. A., & France, pour les investigateurs de l’etude E. (2008). Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): a multinational cross-sectional study. The Lancet, 37.
Brar, R., & Saha, P. K. (2020). In-flight announcements and messages on safety leaflets may be useful to reduce the risk of deep vein thrombosis (DVT) during long distance air travel. Travel Medicine and Infectious Disease, 33, 101515. https://doi.org/10.1016/j.tmaid.2019.101515
Cannegieter, S. C., Doggen, C. J. M., van Houwelingen, H. C., & Rosendaal, F. R. (2006). Travel-Related Venous Thrombosis: Results from a Large Population-Based Case Control Study (MEGA Study). PLoS Medicine, 3(8), e307. https://doi.org/10.1371/journal.pmed.0030307
Caprini, J. A. (2023). Risk assessment as a guide to thrombosis prophylaxis. Current opinion in pulmonary medicine. Current Opinion in Pulmonary Medicine , 16(5), 448–452. https://doi.org/10.1097/MCP.0b013e32833c3d3e
Chandra, D. (2009). Meta-analysis: Travel and Risk for Venous Thromboembolism. Annals of Internal Medicine, 151(3), 180. https://doi.org/10.7326/0003-4819-151-3-200908040-00129
Chaudhary, N., Khan, U., Shah, T., Shaheen, F., Mantoo, S., Qadri, S., Mehfooz, N., Shabir, A., Siraj, F., Shah, S., Koul, P., & Jan, R. (2021). Prevalence and predictors of pulmonary embolism in patients with acute exacerbation of chronic obstructive pulmonary disease. Lung India, 38(6), 533. https://doi.org/10.4103/lungindia.lungindia_79_21
Chen, S., Zhang, D., Zheng, T., Yu, Y., & Jiang, J. (2021). DVT incidence and risk factors in critically ill patients with COVID-19. Journal of Thrombosis and Thrombolysis, 51(1), 33–39. https://doi.org/10.1007/s11239-020-02181-w
Choudhry, V. P., & Upadhyay, A. (2009). Deep vein thrombosis in air travellers. In Journal of Association of Physicians of India (Vol. 57, Issue 9). https://pubmed.ncbi.nlm.nih.gov/20214003/
de Jong, C. M. M., Rosovsky, R. P., & Klok, F. A. (2023). Outcomes of venous thromboembolism care: future directions. Journal of Thrombosis and Haemostasis, 21(5), 1082–1089. https://doi.org/10.1016/j.jtha.2023.02.015
Dimberg, L. A., Mundt, K. A., Sulsky, S. I., & Liese, B. H. (2006). Deep Venous Thrombosis Associated with Corporate Air Travel. Journal of Travel Medicine, 8(3), 127–132. https://doi.org/10.2310/7060.2001.24399
Hayssen, H., Cires-Drouet, R., Englum, B., Nguyen, P., Sahoo, S., Mayorga-Carlin, M., Siddiqui, T., Turner, D., Yesha, Y., Sorkin, J. D., & Lal, B. K. (2022). Systematic review of venous thromboembolism risk categories derived from Caprini score. Journal of Vascular Surgery: Venous and Lymphatic Disorders, 10(6), 1401-1409.e7. https://doi.org/10.1016/j.jvsv.2022.05.003
Johnston, R. V., & Hudson, M. F. (2014). Travelers’ Thrombosis. Aviation, Space, and Environmental Medicine, 85(2), 191–194. https://doi.org/10.3357/ASEM.3822.2014
Kamerkar, D. R., John, M. J., Desai, S. C., Dsilva, L. C., & Joglekar, S. J. (2016). Arrive: A retrospective registry of Indian patients with venous thromboembolism. Indian Journal of Critical Care Medicine, 20(3), 150–158. https://doi.org/10.4103/0972-5229.178178
Karsanji, D. J., Bates, S. M., & Skeith, L. (2020). The risk and prevention of venous thromboembolism in the pregnant traveller. Journal of Travel Medicine, 27(2). https://doi.org/10.1093/jtm/taz091
Kelman, C. W. (2003). Deep vein thrombosis and air travel: record linkage study. BMJ, 327(7423), 1072–0. https://doi.org/10.1136/bmj.327.7423.1072
Koh, C. H. (2021). Commercial Air Travel for Passengers With Cardiovascular Disease: Recommendations for Common Conditions. Current Problems in Cardiology, 46(3), 100768. https://doi.org/10.1016/j.cpcardiol.2020.100768
Krasiński, Z., Chou, A., & Stępak, H. (2021). COVID-19, long flights, and deep vein thrombosis: What we know so far. In Cardiology Journal (Vol. 28, Issue 6). https://doi.org/10.5603/CJ.A2021.0086
Kuipers, S., Cannegieter, S. C., Middeldorp, S., Robyn, L., Büller, H. R., & Rosendaal, F. R. (2007). The Absolute Risk of Venous Thrombosis after Air Travel: A Cohort Study of 8,755 Employees of International Organisations. PLoS Medicine, 4(9), e290. https://doi.org/10.1371/journal.pmed.0040290
Kuipers, S., Venemans, A., Middeldorp, S., Büller, H. R., Cannegieter, S. C., & Rosendaal, F. R. (2014). The risk of venous thrombosis after air travel: contribution of clinical risk factors. British Journal of Haematology, 165(3), 412–413. https://doi.org/10.1111/bjh.12724
Kuipers, S., Venemans‐Jellema, A., Cannegieter, S. C., van Haften, M., Middeldorp, S., Büller, H. R., & Rosendaal, F. R. (2014). The incidence of venous thromboembolism in commercial airline pilots: a cohort study of 2630 pilots. Journal of Thrombosis and Haemostasis, 12(8), 1260–1265. https://doi.org/10.1111/jth.12627
Lapostolle, F., Surget, V., Borron, S. W., Desmaizières, M., Sordelet, D., Lapandry, C., Cupa, M., & Adnet, F. (2001). Severe Pulmonary Embolism Associated with Air Travel. New England Journal of Medicine, 345(11), 779–783. https://doi.org/10.1056/NEJMoa010378
Lutsey, P. L., & Zakai, N. A. (2023). Epidemiology and prevention of venous thromboembolism. Nature Reviews Cardiology, 20(4), 248–262. https://doi.org/10.1038/s41569-022-00787-6
MacCallum, P. K., Ashby, D., Hennessy, E. M., Letley, L., Martin, J., Mt‐Isa, S., Vickers, M. R., & Whyte, K. (2011). Cumulative flying time and risk of venous thromboembolism. British Journal of Haematology, 155(5), 613–619. https://doi.org/10.1111/j.1365-2141.2011.08899.x
Mahmood, F., Harte, C., Allen, D., Clarke, J., & Picard, F. (2022). Perioperative air travel increases the risk of venous thromboembolism following lower limb arthroplasty. European Journal of Orthopaedic Surgery & Traumatology, 33(4), 919–925. https://doi.org/10.1007/s00590-022-03229-8
McKerrow Johnson, I., Shatzel, J., Olson, S., Kohl, T., Hamilton, A., & DeLoughery, T. G. (2022). Travel-Associated Venous Thromboembolism. Wilderness & Environmental Medicine, 33(2), 169–178. https://doi.org/10.1016/j.wem.2022.02.004
Mwansa, H., Zghouzi, M., & Barnes, G. D. (2023). Unprovoked Venous Thromboembolism. Medical Clinics of North America, 107(5), 861–882. https://doi.org/10.1016/j.mcna.2023.05.006
Neeman, E., Liu, V., Mishra, P., Thai, K. K., Xu, J., Clancy, H. A., Schlessinger, D., & Liu, R. (2022). Trends and Risk Factors for Venous Thromboembolism Among Hospitalized Medical Patients. JAMA Network Open, 5(11), e2240373. https://doi.org/10.1001/jamanetworkopen.2022.40373
Parker, S., & Mahomed, O. (2020). Hypoxia and thrombosis in COVID-19: new considerations for air passengers. Journal of Travel Medicine, 27(8). https://doi.org/10.1093/jtm/taaa122
Pérez-Rodríguez, E., Jiménez, D., Díaz, G., Pérez-Walton, I., Luque, M., Guillén, C., Mañas, E., & Yusen, R. D. (2003). Incidence of Air Travel–Related Pulmonary Embolism at the Madrid-Barajas Airport. Archives of Internal Medicine, 163(22), 2766. https://doi.org/10.1001/archinte.163.22.2766
Possick, S. E., & Barry, M. (2006). Air Travel and Cardiovascular Disease. Journal of Travel Medicine, 11(4), 243–250. https://doi.org/10.2310/7060.2004.19009
Ram, S., Ram, H. S., Neuhof, B., Shlezinger, R., Rosenthal, Y. S., Chodick, G., & Yogev, Y. (2022). Does Air Travel During Pregnancy Increase the Risk of Venous Thrombosis? SSRN Electronic Journal. https://doi.org/10.2139/ssrn.4005131
Ram, S., Shalev-Ram, H., Neuhof, B., Shlezinger, R., Shalev-Rosental, Y., Chodick, G., & Yogev, Y. (2023). Air travel during pregnancy and the risk of venous thrombosis. American Journal of Obstetrics & Gynecology MFM, 5(1), 100751. https://doi.org/10.1016/j.ajogmf.2022.100751
Righini, M., & Suhl, J. (2023). Update on venous thromboembolism in pregnancy. JMV-Journal de Médecine Vasculaire, 48(3–4), 97–99. https://doi.org/10.1016/J.JDMV.2023.10.003
Sarkar, P., Srivastava, S., Das, J., & Kumar, A. (2023). Narrative Review on Prevalence of Venous Thromboembolism and Public Awareness in India. Malaysian Journal of Nursing, 15(01), 173–186. https://doi.org/10.31674/mjn.2023.v15i01.019
Scurr, J. H., Machin, S. J., Bailey-King, S., Mackie, I. J., McDonald, S., & Smith, P. D. C. (2001). Frequency and prevention of symptomless deep-vein thrombosis in long-haul flights: a randomised trial. The Lancet, 357(9267), 1485–1489. https://doi.org/10.1016/S0140-6736(00)04645-6
Silverman, D., & Gendreau, M. (2009). Medical issues associated with commercial flights. The Lancet, 373(9680), 2067–2077. https://doi.org/10.1016/S0140-6736(09)60209-9
Singh, S., Kapoor, S., Singh, B., Tandon, R., Singla, S., Singla, T., Bansal, V., Singh, G., Goyal, A., Chhabra, S. T., Aslam, N., Wander, G. S., & Mohan, B. (2021). Real world data on clinical profile, management and outcomes of venous thromboembolism from a tertiary care centre in India. Indian Heart Journal, 73(3), 336–341. https://doi.org/10.1016/j.ihj.2021.02.006
Sinha Kounteya. (2010, January 16). DVT affects air, road travellers. Times of India. https://timesofindia.indiatimes.com/life-style/health-fitness/health-news/dvt-affects-air-road-travellers/articleshow/5452303.cms
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Sarkar, P., Srivastava, S., Mani, S., & Gauba, A. (2023). Risk of Venous Thromboembolism Among Individuals who Frequently Travel by Flight for Work. International Journal of Advancement in Life Sciences Research, 6(4), 15-24. https://doi.org/https://doi.org/10.31632/ijalsr.2023.v06i04.003
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Research Articles
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