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Updated May 5, 2006


Medical Journals The best articles we have found are listed below. If you have time for only one, we recommend the one by Eklof et al. It presents its own results plus a table recapping the findings of other researchers.

To find most of these articles or do research of your own, try the Pubmed website of the National Library of Medicine at Or try various search engines by subject, name of publication or the author.

On some of these bibliography entries we have included brief notes on important points made in the article. Note: "precautions" means author listed risk factors, exercises, etc.

Alberty-Ryoppy A Femoral Neuropathy following anticoagulant therapy for ECS in a young woman
Acta Chir Scand '85 151:643-5

AMA Commission on Emergency Services Medical aspects of transportation aboard commercial aircraft
JAMA 82 247:1007-11

Angrist, A The pathology of the fatal pulmonary embolus
Medical Times, Dec. '66, 1429-34

Arfvidsson, B Risk factor for venous thromboembolism following prolonged air travel
Hematol Oncol Apr '00 391-400
abstract, patient related and cabin related factors

Beighton, TH Cardiovascular disease in air travelers
Br Heart J '68 30:367-72

Belcaro, G Venous thromboembolism from air travel: the LONFLIT study.
Angiology 2001 Jun;52(6):369-74
Largest study yet, nearly 1,900 volunteers. LONFLIT1 Found no victims in group without risk factors, 3.3% developed DVT in group with risk factors. LONFLIT2 found nearly 20 times less risk of DVT with compression stockings. In an unpublished LONFLIT3, (see opening paragraphs at top of this page) found aspirin ineffective, heparin effecive as preventive measures.

Bendz, B Association between acute hypobaric hypoxia and activation of coagulation in human beings
Lancet Nov 11 '00, 1657-8
20 young men in hypobaric chamber; hour-by-hour inreases in clotting factors.

Benigni etc Epidemiological study on the consequences of long distance air flight
Venous Digest '98 European School of Phlebology
compression stockings tested, found effective

Benoit, R Travelers thromboembolic disease. The economy class syndrome
J Mal Vasc (fr) '92 17 suppl B:84-7
abstract 12 cases, 50% had no risk factor other than air travel. Precautions.

Bergqvist, D Incidence of pulmonary embolism: is it declining?
Semin Vasc Surg. 2000 Sep;13(3):167-70.

Bettes & McKenas Medical Advice for Commercial Air Travelers
American Family Physician 9/99
McKenas is now medical director at American Airlines and provided answers to many questions for

Bischoff, A. Economy class syndrome: Preventing thrombosis with foot exercises and supportive
Fortschr Med. 1999 Apr 30;117(12):36. German.
No abstract available, stockings. Travel Medicine Series no. 7: Thrombosis risk on long flights PMID: 10361371

Brown, M Venous thromboembolism associated with air travel
Aviation Space Environmental Medicine '98:
a report of 33 patients, air travel is biggest risk factor (found in 50%), median onset day 4, 82% by day 15

Black, J DVT and PE
Lancet '93 342:352-3

Chiqette, E Comparison of an Anticoagulation Clinic With Usual Medical Care
Arch In Med 98 158:1641

Clagett GP. Prevention of venous thromboembolism.
Heit JA Chest. 1998 Nov;114(5 Suppl):531S-560S. Review.

Cottrell, J Altitude exposures during aircraft flight
Chest Jan '88
6,200 ft altitude potential risk for people with cardiac or pulmonary disease

Cruickshank, J Air travel and Thrombotic episodes: ECS
Lancet Aug 27 '88

Clerel M Thromboembolic syndrome from prolonged sitting and flights of long duration: experience of the Emergency Medical Service of the Paris Airports
Bull Acad Natl Med. 1999;183(5):985-97; discussion 997-1001

Colin, J Physiologic constraints imposed on commercial airline flights
Soins June '84

Eklof, B Venous thromboembolism in association with air travel
Dermatol surg 96;22:637 Honolulu
of 254 DVT/PE patients, 44 were attributable to recent air travel. 36 known previous cases (listed) risk factors included minor injuries to lower limbs.

Emonson Activated protein C as a new cause of DVT in aviators
ASEM '97 68:606

Ferrari Travel as a risk factor for Venous Thromboembolic Disease
Chest '99 115:440 160
Patients with DVTs compared to control group. DVT group four time more likely to have recent travel. Conclusion: travel is a risk factor for DVT; travel alone can cause DVT.

Franzeck UK, Schalch I, Bollinger A.
On the relationship between changes in the deep veins evaluated by duplex sonography and the postthrombotic syndrome 12 years after deep vein thrombosis.
Thromb Haemost. 1997 Jun;77(6):1109-12.

Finch, PJ Thromboembolism and air travel
Lancet '88 1025

Foley, M Air Travel for Patients
Am J Nursing '73 June

Geroulakos, G Economy-class syndrome presenting as phlegmasia caerulea dolens
Eur J Vasc Endovasc Surg 2000 Jul;20(1):102-4 .

Ginsberg, J Management of Venous Thromboembolism - review article
NEJM Dec 12 '96

Glatt, AE 8 year history of PE, DVT
Hosp Pract May 15 '87

Goldhaber, S Pulmonary Embolism - review
NEJM July 9 '98,w

Hamada, Koichiro et al - Effects of Hydration on Fluid Balance and Lower-Extremity Blood Viscosity During Long Airplane Flights
JAMA. 2002;287:844-845. Feb 20

Hart, Y Medical emergencies in the air
Lancet '85 1:353-4

Heit JA. An analysis of current pulmonary embolism therapy.
Int Angiol. 1992 Jan-Mar;11(1):57-63. Review.

Heit JA Prevention of Venous Thromboembolism.
Chest. 2001 Jan;119(1 Suppl):132S-175S. No abstract available.

Heit JA Risk factors for deep vein thrombosis and pulmonary embolism: a population-based case-control study.
Arch Intern Med. 2000 Mar 27;160(6):809-15.PMID: 10737280

Heit JA, Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study.
Arch Intern Med. 1998 Mar 23;158(6):585-93.PMID: 9521222

Hirsh, Jack Management of DVT and PE AmHeartAssn. Incidence, all aspects of management including pregnancy, 451-item bibliography

Hirsh J, Hoak J. Management of deep vein thrombosis and pulmonary embolism: a statement for Healthcare Providers.
Circulation 1996; 93: 2212-2245.

Holliday, J Atypical presentation of multiple pulmonary emboli in a young air traveler
J R Coll Gen Prac '85 35:497

Horton J Warfarin Therapy: Evolving Strategies in Anticoagulation
American Academy of Family Physicians 2/1/99 $5 million warfarin sales

Hughes, R. Frequency of venous thromboembolism in low to moderate risk long distance air travellers: the New Zealand Air Travellers Thrombosis (NZATT) Study. Of 878 passengers, nine developed DVT. People with risk factors such as recent injury or surgery were excluded. Four of the nine were wearing compression stockings.
Lancet, 2003 Dec 20, 362(9401):2039-2044

Kahn, F. consultation paper Aviation Health '00 bibliography
Aviation heath instiute, London

Kierkegaard A. Size of the thrombus in acute deep vein thrombosis and the significance of patients' age and sex.
Acta Chir Scand. 1981 147(4):259-61

Kline, JA New diagnostic tests for pulmonary embolism
Ann Emerg Med. 2000 Feb; 35(2):168-80. Review. PMID: 10650235

Kraaijenhagen, R Travel and risk of venous thrombosis
Lancet Oct 28 '00 Letter

Landgraf, H ECS, fluid balance and lower leg edema
ASEM Oct '94
Simulated 12 hour flight significant but not pathological swelling, exercise didn't help, not likely to cause DVT but people with risk factors should take precautions.

Lapostolle, F Severe Pulmonary Embolism Associated with Air Travel
New England JM Sept. 13, 2001 Volume 345:779-783
Risk of PE increases according to length of flight.

Laursen, SB Air Travel and DVT
Ugeski Laeger June '98 Danish
1 case

Lederman, J Acute PE Following Air Travel
Postgrad Med Feb '83

Levy, Y Is J Occurrence of thromboembolic events following airplane flights ECS
Med Sci Oct 31 '95
precautions recommended

Marespoil, T Thromboembolic complications associated with long air travel
Presse Med Mar 2 '91

Mayo Clinic Health Letter June '98
600,000 PEs, 10% fatal, risk factors

Milne, R Venous Throboembolism and air travel
J R Coll Physicians Lond '92

Mohler, S Frequent Flyers Beware: simple steps can prevent ECS
Wright State Aug 14 '97
Stealth disease, 86 at Heathrow - 18% of flyers, sudden deaths

Mohler, S ECS review - history
ASEM Oct '94
treatment, potentially fatal

Mohr, DN Venous stasis syndrome After DVT or PE
Mayo Clin Proc Dec '00
Studied 1527 case records. Within 20 years 27% of DVT victims develop venous stasis syndrome.

Montanari, G Air Transport of Pregnant Women
Minerva Med '72 63(7)

Morrell, MT Relationship between DVT and PE at autopsy
Br J Surg '73

Moyses, C ECS
Lancet '88 ii:1077

Murtagh, J Air travel
Aust Fam Physician Feb '87

Nehler, MR Effects of elastic compression stockings
J Vasc Surg '93 18:783-8

Nishiyana, G
Reuters Nov '00
Study links 25 deaths to ECS 150 treated each year at Tokyo airport, 50-60 serious. 25 deaths since '92

Nissen, P ECS or Travel Thrombosis
Vasa Aug '97
few victim, 5% of DVT due to air travel

Oger, E Incidence of venous thromboembolism: a community-based study in Western France
Thromb Haemost 2000 May;83(5):657-60

Paganin, F PE on non-stop flights between France and Reuinion Island
Lancet Apr 27 '96 -letter

Patel, A J Air travel and thromboembolic complications after percutaneous nephrolithotomy for staghorn stone
Endourol Feb '98
Air travel causes recurrent PE despite full-dose heparin

Patterson, JE Assuring safe travel for today's elderly
Geriatrics, '89 44:44-57

Patterson, JE The pre-travel medical evaluation: the traveler with chronic illness and the geriatric traveler
Yale J Biol Med. 1992 Jul-Aug;65(4):317-27. Review. PMID: 1290273

Pineo, Graham (, vol. 8 no. 3) finds 150-200K annual PE deaths.

Sarvesvaran, R Sudden natural deaths associated with commercial air travel
Med Sci Law '86 26:35-8

Satoh, A PE developed during airplane flight
Nihon June '98 pulmonary angiography (Japanese)

Scurr, JH How long after surgery does the risk of thromboembolism persist?
Acta Chir Scand Suppl 1990;556:22-4

Scurr, J Frequency and prevention of symptomless deep-vein thrombosis in long-haul flights: a randomised trial
The Lancet, 5/12/01; vol 357 #9267
Ultrasound scans of 200 travelers before and after vacation flights. In group not wearing compression stockings, 10% develop detectable blood clots. None in group wearing compression stockings.

Simon, R ECS risk for travelers
Wien Klin Aug '99
121 ECS victims, 77 DVT 43 PE 12 hour trips, 3.1 days to onset, 59% had no risk factor other than air travel.

Sirven JI, Is there a neurologist on this flight?
Neurology June 2002 58:1739
2,042 medical incidents led to 312 diversions on one airline. Neurologic symptoms were the single largest category of medical incidents, prompting 626 air-to-ground medical calls (31%) and causing 34% of all diversions. Loss of consciousness/syncope was the complaint most likely to lead to a diversion.

Sinzinger, H ECS
Vasa Aug '99
19 cases 42.3 hours to onset, 84% initially diagnosed myocardial infarction no risk factors business and first class victim

PD Stein Clinical characteristics of patients with acute pulmonaryembolism stratified according to their presenting syndromes
Chest, 97 112, 974-979

Steinhauser, RP Deep venous thrombosis in the military pilot
ASEM '89 60:1096-8

Syminton, IS Pulmonary Thromboembolism after travel
Br J Dis Chest '77 71:138-40

Tardy, B Phlebitis following travel
Presse Med. 1993 May 15;22(17):811-4. French.. PMID: 8316545

Teenan, RP Peripheral arterial thrombosis related to commercial airline flights
Br J Clin Prac Autumn '92
Thrombosis in other sites also expected and found myocardial ischaemia is the most common

Thomas J PE hazard of air travel
Cent Af J Med May '81 27:85-87

Vladimir, V Medical limitations to air travel
Rev Paul Med Dec '78 (Portugese)

Weinmann, E DVT review
NEJM Dec 16 '94

Wicki, J Assessing Clinical Probability of PE in the Emergency Ward
Arch Int Med Jan '01
Studied records of 1090 suspected PE, of which 27% (296) were confirmed PE

Wilk, j Unexplained syncope: when to suspect PE
Woman faints, misdiagnosed, dies. Fainted at Stapleton Airport in Denver

Winkel Swelling of the lower leg in sedentary work - a pilot study
(J Human Ergol 1981; 10:139-149)

Winkel Effects of leg activity and ambient barometric pressure on foot swelling and lower limb skin temperature during 8 H of sitting
Eur J Appl Physiol 1988;57:409-414

Wright, HP Effect of posture on venous velocity
Br Heart J 52 014:325-30

Zamula, E PE Difficult but crucial diagnosis
FDA Consumer Nov 1 '89
630,000 PEs - 70k die in first hour. Of 560k survivors, 70%, 400k misdiagnosed. l33k die, of which 100k could be saved with correct diagnosis
50% of DVT victims have no symptoms, and 50% of those will progress to PE.
PE is relatively common at autopsy, usually unexpected, and frequently the cause of death. In fatal PEs 47% were not diagnosed before death.