Association between long travel and venous thromboembolic disease: a systematic review and meta-analysis of case-control studies

Abstract

The term "economy-class syndrome" defines an infrequent episode of venous thromboembolism (VTED) related to a long travel, namely by plane. However, this relation has not clearly been demonstrated by investigators. We carried out a systematic review and a meta-analysis of cases-control studies that had studied this topic. We realised a systematic review of the literature and selected all the casecontrol studies published. Two authors carried out a methodological evaluation according to the Scottish Intercollegiate Guidelines Network items (concordance was analysed by weighted kappa index), and a systematic analysis of the potential biases of each study was assessed. We carried out the meta-analysis with the data extracted from the studies. We recovered eight cases-control studies. The relation between the antecedent of a long travel and subsequent VTED varied from OR=1.1 to OR=4.0 and was found to be significant in four studies. The studies were highly heterogeneous in methodology and so the results obtained about the relation between the long travel and the VTED and the score at SIGN50. Two meta-analysis were carried out: only with travels by plane in which the relation was not significant (OR=1.21; CI 95%, 0.95-1.55) and with all types of transport, with a slightly significant relation (OR= 1.46; CI95%, 1.24-1.72). We may deduce from this systematic review that there does exist a weak association between episodes of VTED and a long travel, but not by plane specifically. The heterogeneity and the methodological quality of the studies published preclude of more robust conclusions.

Medical issues associated with commercial flights

“…An individual needs in-fl ight oxygen if PaO 2 falls below 50 mm Hg or if the oxygen saturation measured via pulse oximetry falls below 85%. of 1·59 (95% CI 1·04-2·43) from case-control studies 27,[38][39][40][41] and a relative risk of 2·93 (95% CI 1·5-5·58) from several prospective controlled cohort studies. 38,40 These results are consistent with those of the population-based (MEGA) study (OR 1·7, 95% CI 1·0-3·1).…”

Self‐care management of heart failure: practical recommendations from the Patient Care Committee of the Heart Failure Association of the European Society of Cardiology

“…Specific evidence relating to travel for HF patients is limited and relies on that derived for cardiac patients in general and the elderly. Any intention to travel should be discussed with a health‐care professional prior to making any arrangements 105,106. Heart failure patients are at higher risk of developing deep vein thrombosis and pulmonary emboli during prolonged air travel 106,107.…”

“…Any intention to travel should be discussed with a health‐care professional prior to making any arrangements 105,106. Heart failure patients are at higher risk of developing deep vein thrombosis and pulmonary emboli during prolonged air travel 106,107. A meta‐analysis identified that although there appears to be a weak link between prolonged travel and embolic events, many of the randomized controlled studies showed the study populations had fewer risk factors than most and therefore the risks are often underestimated in a HF population.…”

Relation between Air Travel and Venous Thromboembolism

“…However, not only is the risk of VTE increased by air travel, but also by other modes of transport. Car, bus, and train transport are also predisposing risk factors to this condition (84) . What this implies is that the increased risk of VTE is mainly attributed to protracted restricted mobility, rather than the environment within the cabin of an airplane.…”