What is travelers' thrombosis: Causes and symptoms? How to avoid it?

What is travelers' thrombosis? Do you know that it is the excessive formation of blood clots?

What are its causes, manifestations and risks?
Can it be prevented?
For more information, read with us...

Tourism is the fastest growing industry ever. It is currently booming and accounts for up to 30% of all the world's services that people like to use.

The fastest and still the most popular mode of transport is air travel. Despite the many air accidents, disasters and terrorist attacks on planes that can be reported in the media, planes are still considered the safest means of transport.

But are they really as safe as we think?

What health risks do we take in connection with flying?

Even the most comfortable transport has its weaknesses. Its weaknesses stem from the environment and conditions on board the aircraft. Even the most luxurious airline cannot control most of them. Unfortunately, some changes would compromise the safety of the flight itself.

1. Cramped quarters - Increase the risk of spreading infections through droplets or direct contact, cause oppression of certain parts of the body and impair blood circulation, prevent movement, increase the risk of lower limb swelling and thrombosis.
2. Dry air - Causes scratchy throat, irritation to cough, faster spread of microorganisms and development of infections.
3. Changes in barometric pressure - Causes increased blood pressure, burst blood vessels, bleeding, bleeding post-surgical wounds, tinnitus, damage to eardrums, aggravates respiratory and cardiac disease, and causes pulmonary embolism.
4. Mode of transport - Causes fear, palpitations, heart rhythm disturbances, anxiety, panic attacks, nausea, vomiting.

Interesting:
Scientific studies have confirmed the increased risk of blood clots and venous thrombosis during flight. It increases up to four times. It is slightly less if you sit in an aisle seat. There is more leg movement. The most convenient and spacious seats are those near emergency exits. However, these are often charged for because even airlines are aware of their benefits.

What about ground transport?

The situation is similar with regard to venous thrombosis and travel on ground transport. Those who regularly travel longer distances may suffer from increased blood clots in the lower limbs.

These are mainly professional drivers (taxi drivers, truck drivers...).

Do you want to know more about travelers' thrombosis?
What are the predisposing factors for its occurrence?
How does it manifest itself and can it be complicated?
Is there an effective prevention and what are the treatment options?
Read on with us.

What is travellers thrombosis?

Travelers' thrombosis is a deep vein thrombosis of the lower extremities occurring in association with travel that usually lasts 4 hours or more.

The popularity of intercontinental flights has therefore brought with it an increased risk of thromboembolism. Not only have multi-hour plane journeys increased the opportunities for tourists to explore previously unknown countries, but cases of economy class syndrome, another name for traveller's thrombosis, have also increased.

Due to the interplay of multiple factors that occur during extended travel, a blood clot (thrombus) forms in the deep venous system.

The thrombus creates an obstruction in the blood vessel, causing it to obstruct and restricting or completely stopping blood flow through the area.

Blood in the affected limb cannot drain normally, causing further changes and associated symptoms.

Predisposing and inciting factors for travel thrombosis

The development of a travel-related blood clot occurs in predisposed individuals. These are people who are predisposed to developing the disease before travel.

By predisposition, we usually mean the patient's current condition and associated diseases.

The flight itself creates conditions that evoke the development of thrombosis. Lack of space, inability to move the limbs, their forced position and lowering, changes in barometric pressure - all contribute to its development.

Interesting:
Venous thrombosis of the lower limbs occurs during flight, but is much more common within a week or so of flight.

Under physiological circumstances, blood does not clot in the blood vessels. The so-called Virchow triad also plays a large role here, which includes three basic components for the development of venous thrombosis. These are blood clotting disorders, damage to the vessel wall and disorders of blood flow in the blood vessels.

Virchow's triad:

• blood clotting disorders - disorders of haemocoagulation (thrombophilic state, history of thromboembolism, increased clot formation due to hormonal drugs, drugs...)
• damage to the vascular wall - damage to the vascular endothelium (diabetes, varicose veins, inflammation of the veins, trauma, surgery...)
• blood flow disorders - blood stasis (immobility and position of the limbs, varicose veins, tight clothing...)

Table of risk factors for thromboembolism

The following articles also contain interesting information:

• Thrombosis: A disease of the old? It also threatens the young + Causes and manifestations
• Deep vein thrombosis
• Thrombophlebitis of the superficial veins
• Thromboembolic disease
• Chronic venous disease
• Chronic venous insufficiency

How does travelers' thrombosis manifest itself?

The above factors cause the blood to stagnate in the lower limbs (to be retained, to stop).

This phenomenon is called blood stasis.

It occurs due to the fixed position of the limbs, which are lowered for several hours, due to gravity, which directs the blood downward. The failure of the muscle pump due to lack of movement and immobilization of the legs also contributes to this.

The accumulated blood causes the volume of the limbs to increase by about 4%.

This "bulkiness" is visible to the naked eye. It appears as swelling of the limbs.

The venous stasis is exacerbated by a drop in the barometric pressure in the cabin, with a consequent reduction in the amount of oxygen in the blood (hypoxia). The drop in pressure also results in activation of the coagulation system - a hyperthrombotic state. In practice, this means that there is an increased formation of blood clots.

If a blood clot clogs a blood vessel, the tissue that was previously nourished by it is ischemic. This is manifested by soreness of the affected limb (more commonly the left).

Manifestations of traveler's thrombosis:

1. swelling of the affected limb.
2. soreness of the affected limb
3. tingling, tingling, reduced sensitivity in the limb
4. change in temperature of the limb - the affected limb is colder to the touch than the healthy limb
5. change in the colour of the limb (starting in the toe area, moving upwards) - initial pallor, later turning blue (cyanosis)

5 complications that can arise from travel thrombosis

The most common acute complication of traveler's thrombosis is pulmonary embolism, and the most common chronic complication is undoubtedly post-thrombotic syndrome.

Nevertheless, less frequent and equally serious to life-threatening complications can arise.

1. Pulmonary embolism

Pulmonary embolism is justifiably the most serious complication of venous thrombosis, with a 15% mortality rate. Up to 80% of cases arise from lower extremity thrombosis.

It occurs when a blood clot (thrombus), or part of it, formed in a blood vessel of the lower limb breaks off and travels further through the bloodstream. The clot travelling through the bloodstream is called an embolus.

The embolus travels to the right atrium of the heart, thence to the right ventricle and finally to one or more pulmonary vessels. It mechanically occludes these, causing severe damage to the lungs.

Manifestations of pulmonary embolism:

• sudden death
• sudden onset of stabbing chest pain on the affected side
• dyspnoea at rest, worsening on exertion
• marked pallor in the face
• bluish discoloration of the lips
• cold sweat
• palpitations
• rapid heartbeat

2. Stroke

If an embolus is lodged in a blood vessel in the brain, a stroke, stroke or cerebral infarction occurs.

The blockage of a cerebral artery causes the blood supply and oxygenation of the part of the brain to be inadequate, causing ischaemia and gradual death.

Early thrombolytic treatment (dissolution of the clot) is essential not only to save the life of the affected patient, but also to prevent permanent disability due to paralysis of the limbs and speech or visual impairment.

Manifestations of stroke:

• sudden death
• sudden onset of unconsciousness
• paresthesia to paralysis of half the body
• gait disturbances, falls
• speech disorders (slurred speech, complete inability to speak)
• visual disturbances to blindness
• swallowing disorders
• pallor in the face
• cold sweat
• nausea, vomiting
• usually high blood pressure

3. Acute heart attack

Acute myocardial infarction occurs on the same basis as pulmonary embolism and stroke. However, a thrombus travelling through the bloodstream does not pass through the heart to the cerebral and pulmonary vessels, but clogs the coronary arteries that provide nutrition to the heart muscle (myocardium).

Despite significant advances in the treatment of heart attacks, its occurrence can cause rapid death with the impossibility of early treatment.

Sudden death from coronary embolization occurs mainly when multiple vessels are affected at once, with subsequent ischemia of a large part of the heart muscle. This causes significant impairment of cardiac function and cardiac arrest.

Manifestations of acute myocardial infarction:

• sudden death
• sudden onset of unconsciousness
• sudden onset of pressure or burning pain in the centre of the chest (radiating to the neck, back, limbs and stomach)
• sudden onset of pain in the stomach area (infarction of the lower wall of the heart, in diabetics)
• various rhythm disturbances (individual severity)
• shortness of breath of varying degrees
• cold sweats
• pallor in the face
• in some cases peripheral cyanosis
• nausea, vomiting

4. Phlegmasia coerulea dolens

If thromboembolism of the lower limbs is underestimated or if the symptoms are not known and the diagnosis and treatment are late, the condition progresses. The lack of blood supply and the subsequent ischaemia of the vessels of the lower limbs leads to gradual, irreversible tissue death.

A serious form of venous thrombosis is phlegmasia cerulea dolens, which translates as painful blue oedema. This form or late treatment leads to necrosis of the limb with the need for amputation.

Amputation of the limb is a necessity in such severe conditions to prevent the gangrene from progressing higher and causing a septic condition (popularly, blood poisoning).

Manifestations of phlegmasia cerulea dolens:

• sudden onset of pain in the affected limb of severe intensity
• marked swelling of the limb
• blue discolouration of the limb

5. Post-thrombotic syndrome

Postthrombotic syndrome is one of the most severe chronic complications of thromboembolism in the lower limbs.

It arises from a damaged blood vessel (vascular stenosis) with destruction of the underlying valve and a tendency to venous hypertension (increased pressure in the vein).

In addition to the unpleasant manifestations of the post-thrombotic state, patients are also at high risk of recurrence of thrombosis in the damaged vessel, as well as the risk of developing the above-mentioned acute complications.

Manifestations of post-thrombotic syndrome:

• chronic pain in the affected limb
• pain-related gait disturbance
• insomnia, frequent night waking
• depression
• swelling
• skin changes (colour changes, ulceration - formation of ulcers, wetting, suppuration)

Prevention, diagnosis and treatment

To some extent, the development of some diseases can be prevented. The same is true for travelers' thrombosis.

Particular caution should be exercised by high-risk patients. People at high risk of whom several serious predispositions are present should consider longer flights.

Basic Precautions:

• Limb movement (bending and extending legs, stretching whenever possible).
• massage of the lower limbs, if the situation permits
• antithrombotic (compression) stockings
• drinking regime, hydration, avoidance of antidiuretics
• non-use of sedatives and antihypnotics
• omitting alcohol, cigarettes before the trip
• preventive administration of heparin by a physician prior to travel in available patients
• preventive use of acetylsalicylic acid (acylpyrine, anopyrine, medipyrine) before travel in available patients

Can it be treated?

After a correct diagnosis, based on symptoms, vascular (Doppler) and blood tests (D-dimer level), treatment can be started.

Premedication with antithrombotic drugs is possible before the exact diagnosis is made, if there is no contraindication for the individual patient.

Interesting:
An elevated blood level of D-dimer is only a guideline parameter. Its fluctuations are also caused by inflammatory processes in the body.

In the treatment, antithrombotic and thrombolytic therapy is used.

The latter acts on the blood clot, which it dissolves, relaxes the obstructed vessel and restores blood supply. With timely administration of drugs, the condition is corrected.

In the case of a severe condition with tissue necrosis, amputation of the lower limb is indicated. The amount of amputation is indicated by the vascular surgeon.