Common Misconceptions

If I am in good shape, it won't happen to me. Athletic people are at much greater risk than other passengers. See our Athletes page. No one is safe from this. More than half the victims have no risk factor other than air travel. On our Messages page you will see remarks from victims who were young, fit, and active: champion cyclists, runners, a scuba diver. A ten year old girl suffered DVT on a flight to Hong Kong.

Older folks are more at risk. Kevin Wake had heard this. On a flight from Singapore to London with his daughter Alayn, 28, he was wearing compression stockings to prevent clots. Shortly before reaching London, Alayn died from a pulmonary embolism. In our registry of cases, 85% are under age 60.

I'll just upgrade and avoid the cramped seats. At cabin altitude, blood coagulability rises steadily and the altitude is the same in the front of the plane as in the rear. A Japanese study found 70% of victims in coach class, 25% in business class, 5% in first class, and one pilot. The term economy class syndrome (ECS) is a misnomer. The ratio of victims is the same in all sections of the aircraft, including the flight deck. Gianni Belcaro's latest study, LONFLIT IV, Business 2003, finds 4.5% of frequent business class travelers developing one or more clots per year.

You just need to stretch if you feel a cramp. You probably won't feel a cramp, and if you do, it's too late. Researchers find that 94% of blood clots are silent, symptomless. John Scurr found symptomless blood clots in 10% of air travelers. But symptomless blood clots are not harmless. They can progress to fatal pulmonary embolism without warning .

If I get a clot, drugs will dissolve it. The usual heparin/warfarin treatment doesn't dissolve the clot. It arrests clot formation. The original clot has to be broken down in a natural process called lysing, which can take months. Getting a correct diagnosis and treatment often takes several weeks. During this time the clot is doing permanent damage, often resulting in chronic phlebitis which can be disabling. A clot-dissolving treatment is available if you can get to Dr. Richard Chang before the clot is more than two weeks old. See the News page, 6/26/02, Dr. Richard Chang.

Pilots acclimate. They don't need to worry. Pilots are at risk, too, and the first sign often is fainting. Dr. David McKenas, medical director at American Airlines, says that the most common causes of sudden pilot incapacitation are cardiac arrest, arrhythmia, and fainting. (All of which are often caused by a blood clot in the lung.) With DVT, pilots, like other victims, often struggle with symptoms for days or weeks, not knowing what is wrong. During that time they are at risk of sudden collapse, a danger to themselves and their passengers. Pilots are also at risk of sudden collapse due to arterial clots causing heart failure or stroke.