Economy class syndrome: what is it and who are the individuals at risk?

Rev Bras Hematol Hemoter. 2017 Oct – Dec;39(4):349-353. doi: 10.1016/j.bjhh.2017.05.001. Epub 2017 May 26.

Dusse LMS(1), Silva MVF(2), Freitas LG(2), Marcolino MS(2), Carvalho MDG(2).

Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil. Electronic address: lucidusse@gmail.com.

Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.

Abstract

The term “Economy Class Syndrome” refers to the occurrence of thrombotic events during long-haul flights that mainly occur in passengers in the economy class of the aircraft. This syndrome results from several factors related to the aircraft cabin (immobilization, hypobaric hypoxia and low humidity) and the passenger (body mass index, thrombophilia, oral contraceptives or hormone replacement therapy, cancer), acting together to predispose to excessive blood coagulation, which can result in venous thromboembolism. Several risk factors, both genetic and acquired, are associated with venous thromboembolism. The most important genetic risk factors are natural anticoagulant deficiencies (antithrombin, protein C and protein S), factor V Leiden, prothrombin and fibrinogen gene mutations and non-O blood group individuals. Acquired risk factors include age, pregnancy, surgery, obesity, cancer, hormonal contraceptives and hormone replacement therapy, antiphospholipid syndrome, infections, immobilization and smoking. People who have these risk factors are predisposed to hypercoagulability and are more susceptible to suffer venous thromboembolism during air travel. For these individuals, a suitable outfit for the trip, frequent walks, calf muscle exercises, elastic compression stockings and hydration are important preventive measures. Hence, it is essential to inform about economic class syndrome in an attempt to encourage Brazilian health and transport authorities to adopt measures, in partnership with the pharmaceutical industry, to prevent venous thromboembolism.