Venous Thromboembolism

Venous Thromboembolism (VTE) is a combination of 2 conditions: Deep Venous Thrombosis (DVT) and Pulmonary Embolus (PE). DVT is the formation of thrombi (clots) in the deep veins, and PE is the migration (embolization) of those clots from the legs to the heart and lungs. VTE is potentially life-threatening, as the emboli can “clog up” the heart or lungs, stopping blood flow.

VTE can occur in anyone, but is more common in certain groups. In 1856, Dr. Rudolf Virchow formulated what is known as Virchow’s Triad, which consists of:

  • Alteration in normal blood flow (stasis)
  • Injury to the vascular endothelium (venous injury)
  • Alteration of the blood constitution (thrombophilia or hypercoagulable state)


Anything that minimizes these three predisposing factors will decrease your chance of developing VTE. Stasis is eliminated by frequent ambulation or exercise, and by wearing sequential compression devices if you are unable to get out of bed. Minimally-invasive surgical techniques can diminish the incidence of venous injury. Thrombophilia can be offset with the use of Lovenox, Coumadin, or other blood thinners during and after an operation. You should bring all of these issues up with your surgeon before agreeing to go the operating room. He / she should be happy to discuss them with you.

“Economy Class Syndrome” and “Travelers DVT” are names first used by the media in the 1980’s to describe VTE in long-haul airline passengers. As described above, VTE is a serious medical condition that can occur in anyone. It is not confined to Economy Class air travelers. It can just as easily occur in First Class airline passengers; or in those traveling by car, train, boat, etc. The mechanism for VTE in travelers is probably due to a combination of immobilization, dehydration, and possible underlying factors. It has been estimated that 3-5% of all air travelers develop DVT, most of which are clinically silent.

Routine prevention of Travelers DVT in patients without elevated risk factors consists of:

  1. Adequate hydration – Drink plenty of liquids such as Gatorade, water, juice, etc. Avoid alcoholic beverages and caffeinated beverages, as these tend to cause dehydration.
  2. Perform calf muscle exercises such as toe-ups while in your seat. These should be done five or more times in a row firmly and deliberately, but not strenuously. (If you are bothering your seat mates, you are doing it too vigorously. This helps to keep the blood in your legs from becoming stagnant, and should be repeated about every 30 minutes.
  3. Get up and walk around a little bit about once an hour. This also helps to keep the blood in your leg veins circulating. While in an airplane, this must be balanced against the risk of getting out of your seat during times of turbulence, etc.
  4. Wear Medical Graded Compression Stockings (Not elastic support hose or T.E.D. Hose) while traveling. These must be properly fitted, and as such, require a doctor’s prescription. Wear loose-fitting, non-restrictive clothing.

Seek immediate medical attention if your leg becomes painful and swollen. Risk factors for DVT include: personal or family history of DVT, recent surgical procedure, prolonged bedrest, long-distance travel, smoking cigarettes, being pregnant, known thrombophilia, taking hormones or The Pill, etc.