Experts call it “economy class syndrome” – but it can happen to anyone in any class of aircraft.
Deep vein thrombosis (DVT) occurs when blood clots in one or more veins.
It can happen at any time, but people on long-haul flights are at higher risk because they sit there for long periods, says Dr. Pinakin V. Parekh, a consultant cardiologist at the Harley Street Heart and Vascular Centre in Singapore.
“In theory, passengers in the better classes – business class, first class – have more room to move around and stretch their legs,” he told CNBC Travel. “So it's all about space on the plane.”
However, Parekh emphasizes that the so-called “economy class syndrome” does not matter where you sit or how often a traveler flies.
“I've had patients who even traveled in business class and developed DVT,” he said. Plus, “if you decide not to fly, it may be the only flight of your life.”
What increases the risks
Deep vein thrombosis typically occurs in the legs. Symptoms include pain, swelling, changes in skin color and a feeling of warmth, but according to the Mayo Clinic, some people have no signs at all.
According to the medical center, people who are overweight, over 60, taking the pill, undergoing hormone replacement therapy or smoking have a higher risk of developing deep vein thrombosis.
But flying carries its own risks, said Parekh.
“Every 5,000 flights, a patient may develop deep vein thrombosis simply due to the risk of air travel,” he said.
A 52-year-old former banking businessman reported suffering a deep vein thrombosis following a four-hour flight from Singapore to Hong Kong.
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The risk is greater on long-haul flights, but deep vein thrombosis can also occur on shorter flights, he said.
“Eight hours of flight time used to be considered the benchmark,” he said, “but some data suggest that even four hours is now considered sufficiently long.”
Alok Tapadia, one of Parekh's patients, said he developed deep vein thrombosis as a result of a four-hour flight from Singapore to Hong Kong.
Tapadia is Parekh's patient.
He said he plays badminton three times a week and knew something was wrong when he became out of breath while climbing stairs after arriving in Hong Kong.
“One of the escalators stopped working,” Tapadia said, so he took the stairs. “I had to stop for a while and wondered what had happened to me.”
It was only when he returned to Singapore, still out of breath and with an elevated pulse, that he finally went for a check-up.
He said doctors told him a blood clot had traveled to the pulmonary artery that connects his heart to his lungs.
Such episodes really shake you up.
He said his first scan showed enlargement of the heart, which occurs when the heart pumps too hard. A second scan resulted in Tapadia being immediately admitted to the hospital's intensive care unit, he said.
Doctors found a “massive” lack of oxygen and his lungs were completely blocked, he said.
Doctors said the situation was “critical because the pressure on the heart was so great that cardiac arrest or a more critical stage could have occurred at any moment,” Tapadia said.
Blood thinners did not dissolve the clot quickly enough, he said.
So his doctors eventually resorted to a cardiac catheterization, in which a catheter is passed through his blood vessels near his heart to dissolve the blood clot from the inside, Tapadia said.
Tips for reducing DVT
According to the Mayo Clinic, deep vein thrombosis can develop into pulmonary embolism, a potentially life-threatening complication that occurs when a blood clot breaks loose and becomes lodged in a blood vessel in the lungs.
If a clot travels to the lungs, symptoms such as shortness of breath and chest pain can occur, Parekh said.
There is no way to completely eliminate the risk of deep vein thrombosis, says Parekh. But there are ways to reduce the risks when flying, he says.
The Mayo Clinic recommends drinking plenty of water, standing and walking around the plane during the flight, circling your ankles while sitting, and wearing support stockings.
Parekh has a simple tip for passengers: choose an aisle seat.
It “encourages you to get up and go much more easily, because when you're at the back of the line you're always afraid of disturbing the guy. [next to you]”, says Parekh.
More than a year later, Tapadia said he has returned to his normal routine, which includes traveling and playing badminton, but he has changed some of his travel habits, starting at the airport.
Now he walks through the airport instead of using the moving walkway, he said. He also walks up and down the aisles during the flight, he said.
He advises travelers to pay attention to their health and possible warning signs.
“An episode like this really shocks you,” he said.
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