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Immobility is known to be one factor that can contribute to the formation of blood clots in the deep veins—so-called “deep vein thrombosis” or DVT. Research has shown that DVT can result from prolonged immobility; for instance, during long-distance travel by car, bus, train or air.

Most cases of DVT occur in the legs (calf area), but they can also occur in other parts of the body such as the thigh and arms. Blood normally flows quickly through these veins, helped along by the movement of the muscles, which squeeze the veins and protect against clotting. Prolonged immobility, especially when seated, can lead to the pooling of blood in the legs, which in turn may cause swelling, stiffness and discomfort.

Diagnosis and Treatment

The risk of developing DVT when traveling is increased in the presence of other risk factors, including:

  • Older age—the risk is greater every year after 50 years old.
  • Cancers—sufferers of metastatic cancers, acute leukemias and myeloma carry a greatest risk.
  • Obesity—increased risk begins at greater than 35 kg/m BMI.
  • Hormone treatments—all forms of exogenous estrogen (e.g. oral contraceptive pills, transcutaneous, vaginal ring, depot progestin injections, hormone replacement), with worst risk in the first months of therapy.
  • Genetic predisposition, personal and/or family history of DVT—patients with inherited thrombophilias are often unaware of their condition until diagnosed with their first DVT.
  • Certain diseases and conditions—such as varicose veins, chronic atrial fibrillation, inflammatory bowel disease, lupus erytematosus, heart failure, heart attack, arterial disease.
  • Pregnancy—increasing risk with each trimester due to the increase in the concentration of clotting factors in the blood.
  • Surgical operation—surgical procedures lasting longer than 60 minutes, such as abdominal, hip or leg surgeries.
  • Any illness or injury that causes immobility—such as those with leg fracture(s), patients who are admitted at the ICU (bedridden for over three days).
  • Smoking—this is not an independent risk factor, but it increases the risk of cancers and other co-morbidities, working synergistically with other risk factors such as the contraindication for estrogen oral contraceptive pill use.

The combination of long-distance travel with one or more of these risks may increase the likelihood of developing a blood clot. It is advisable for travelers with one or more of these risk factors to seek specific medical advice from your doctor well before embarking on a transportation mode of four or more hours to protect your health.

Signs and Symptoms of DVT

It’s helpful to know the signs and symptoms so you can recognize them if you develop DVT. The following are the ones that occur in the affected part of the body (usually in one leg, above or below the knee):

  • Swelling—one calf or thigh may be larger than the other.
  • Edema—when the swollen area is pressed with a finger, a depression may remain.
  • Swelling—along the vein of the leg.
  • Warmth—A feeling of increased warmth in the leg area that is swollen or painful.
  • Leg pain—which may increase when standing or walking.
  • Tenderness of the leg—which may be confined to one area.
  • Color— bluish or red change in leg skin color.

Reducing Risk while Traveling

You can reduce your risk of DVT by taking the following steps:

  • Keep hydrated by drinking plenty of fluids. Dehydration causes blood vessels to narrow and the blood to thicken, increasing the risk for DVT; reduce alcohol and coffee consumption, which both contribute to dehydration.
  • Walk around for five minutes every one or two hours: keep moving your legs to help the blood flow, even when waiting in the airport terminal.
  • Avoid crossing your legs.
  • Wear comfortable, loose-fitting clothing—consider wearing compression stockings, which put gentle pressure on the leg muscles If you’re at higher risk of getting DVT.
  • Do leg exercises while seated—stretch and move your legs frequently; try clenching and releasing your calves and thighs or lifting and lowering your heels with your toes on the floor.

Diagnosis and Treatment

Sudden onset of chest pain, shortness of breath—these are serious symptoms that require medical attention right away. This can be a sign that a clot has broken loose and traveled to your lungs. This is called a Pulmonary Embolism (PE) which is a life-threatening condition.

Before seeing a doctor, what can you do?

  • For symptom relief, apply a warm compress or heating pad on the affected leg to promote circulation and reduce pain.
  • Bed rest with legs elevated to reduce swelling.
  • Wear elastic support stockings to help increase the flow of blood from your legs.
  • Avoid rubbing or massaging the affected area (a clot could break loose).

Specific treatment will be determined by your physician based on your history, her physical examination findings in conjunction with imaging studies, and laboratory test results taking into consideration your opinions or preferences and expectations for the course of the disease.

Dr. Hazel Gallardo-Paez

Family Medicine – Family Medical Practice Danang