Coagulation changes and edema formation during long-distance bus travel

Schobersberger, Wolfgang; Mittermayr, Markus; Innerhofer, Petra; Sumann, Günther; Schobersberger, Beatrix; Klingler, Antón; Simmer, Markus; Streif, Werner; Fischbach, Uwe; Fries, Dietmar

doi:10.1097/01.mbc.0000114438.81125.cf

Cited by 52 publications

(40 citation statements)

References 31 publications

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“…Prolonged recumbency and sitting were shown to activate the coagulation cascade significantly. 41 According to the present findings, prolonged standing, but of much shorter duration, produces a similar effect. Therefore, occupations requiring prolonged standing, such as cashiers, military services, and guards, could predispose to increased hypercoagulability.…”

Section: Perspectives and Clinical Implicationssupporting

confidence: 76%

Orthostatic Hypercoagulability

et al. 2008

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Abstract-Orthostatic stress causes significant plasma shift and raises transmural pressure in lower extremities, resulting in an increase in endothelial activation and plasma proteins concentrations, possibly including coagulation factors. This may lead to activation of the coagulation system during standing. To test this hypothesis, we recruited 18 healthy volunteers (9 females and 9 males; mean age: 25Ϯ1.2 years; body mass index: 21.7Ϯ0.5 kg/m 2 ). Hemodynamics, plasma shift (extrapolated from sequential hematocrit concentration), plasma proteins, and coagulation tests, including procoagulants; fibrinogen, factor V, and factor VIII activity; prothrombin fragments 1 and 2; and endothelial activation-related factors (tissue factor and von Willebrand factor), as well as protein C global pathway, were determined at rest supine and at 15 minutes, 30 minutes, and 60 minutes of still standing. Thirty minutes of standing caused a decrease in plasma volume by 12.0Ϯ0.5% and an increase in plasma protein by 13.0Ϯ0.7%. Fibrinogen, factor V, and factor VIII activity rose by 12.0Ϯ1.2%, 13.0Ϯ1.0%, and 40.0Ϯ6.0% (PϽ0.002 for all), respectively. Prothrombin fragments 1 and 2 were elevated by 150.0Ϯ30.0%. Tissue factor and von Willebrand factor increased by 30.0Ϯ9.0% and 17.4Ϯ51.0% (PϽ0.02 for both), respectively. However, protein C assay results decreased from 0.95Ϯ0.20 to 0.83Ϯ0.16 (PϽ0.001). We hereby introduce a novel physiological mechanism, "orthostatic procoagulation," that should be considered during coagulation tests. Furthermore, it could be extrapolated to the pathophysiology of stasis and venous thromboembolism.

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Section: Perspectives and Clinical Implicationssupporting

confidence: 76%

Orthostatic Hypercoagulability

et al. 2008

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“…5,6 The mechanism of thrombus formation during air travel, however, is unclear. Immobilisation for long periods could play a part, 7,8 as could flight specific factors-eg, hypobaric hypoxia, which might activate the clotting system. Bendz and colleagues 9 exposed volunteers to a hypoxic and hypobaric environment similar to that in an airplane.…”

Section: Introductionmentioning

confidence: 99%

Activation of coagulation system during air travel: a crossover study

et al. 2006

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SummaryBackground There is an increased risk of venous thrombosis after air travel, but the underlying mechanism is unclear. Our aim was to ascertain whether flying leads to a hypercoagulable state.Methods We did a crossover study in 71 healthy volunteers (15 men, 56 women), in whom we measured markers of activation of coagulation and fibrinolysis before, during, and after an 8-h flight. The same individuals participated in two control exposure situations (8-h movie marathon and daily life) to separate the effect of air travel on the coagulation system from those of immobilisation and circadian rhythm. To study the effect of risk factors for thrombosis, we included participants with the factor V Leiden mutation (n=11), those who took oral contraceptives (n=15), or both (n=15), as well as 30 individuals with no specific risk factors.Findings After the flight, median concentrations of thrombin-antithrombin (TAT) complex increased by 30·1% (95% CI 11·2-63·2), but decreased by 2·1% (Ϫ11·2 to 14) after the cinema and by 7·9% (Ϫ16·2 to Ϫ1·2) after the daily life situation. We recorded a high response in TAT levels in 17% (11 of 66) of individuals after air travel (3% [2 of 68] for movie marathon; 1% [1 of 70] in daily life). These findings were most evident in the group with the factor V Leiden mutation who used oral contraceptives. We noted a high response in all variables (prothrombin fragment 1 and 2, TAT, and D-dimer) in four of 63 (6·3%) volunteers after the flight, but in no-one after either of the control situations.Interpretation Activation of coagulation occurs in some individuals after an 8-h flight, indicating an additional mechanism to immobilisation underlying air travel related thrombosis. hypoxia controlled for effects of immobilisation at ground level and for circadian rhythm. We drew blood before, during, and after each exposure, at the same time of day. For the first exposure situation, we chartered a Boeing 757 for a non-stop day flight of 8 h from and to Schiphol airport, Amsterdam. We instructed volunteers not to smoke, use drugs, drink alcohol, or take any prophylactic measures to prevent thrombosis-eg, heparin or aspirin use, or wearing of elastic stockings during the flight-to remain seated as much as possible, and to keep a structured record of fluid intake. 2-3 weeks after the flight, all participants sat for 8 h (for practical reasons two sessions with half the participants in each) in a cinema. We imposed the same restrictions during this second exposure situation as in the first with respect to moving, drugs, smoking, and drinking, and again asked participants to keep a record of their fluid intake. For the final exposure situation, 2 weeks after the movie marathon, we asked participants to live their lives as they normally would for a day, recording fluid intake. We asked participants not to drink alcohol, take drugs, or smoke, but did not restrict movement. We asked participants to keep their food and fluid intake constant during the three exposures.Experienced technicians did the blood ...

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“…704,705 After air travel, this results in a 2-to 4-fold increased risk in the incidence of venous thrombosis, especially after long flights. 706 Although this may occur in people with normal cardiac anatomy and function, children and adults with CHD may be at higher risk for thrombosis during periods of immobilization because of their cardiac malformations, potential propensity to coagulopathy, or impaired myocardial function (section 4.1, Propensity to Coagulopathy in Children With Heart Disease).…”

Section: Air Travel Immobilizationmentioning

confidence: 99%