Fluid loss does not explain coagulation activation during air travel

Anja J. M. Schreijer; Suzanne C. Cannegieter; Marianna Caramella; Joost C. M. Meijers; Raymond T. Krediet; Ries M. Simons; Frits R. Rosendaal

doi:10.1160/TH07-11-0681

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2008; 99(06): 1053-1059
DOI: 10.1160/TH07-11-0681

Blood Coagulation, Fibrinolysis and Cellular Haemostasis

Schattauer GmbH

Fluid loss does not explain coagulation activation during air travel^[*]

Anja J. M. Schreijer

¹Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands

²Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands

,

Suzanne C. Cannegieter

¹Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands

,

Marianna Caramella

³Department of Internal Medicine, University of Milan, Milan, Italy

,

Joost C. M. Meijers

²Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands

,

Raymond T. Krediet

⁴Department of Nephrology, Academic Medical Center, Amsterdam, the Netherlands

,

Ries M. Simons

⁵Security and Safety, TNO Defence, Soesterberg, the Netherlands

,

Frits R. Rosendaal

¹Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands

⁶Thrombosis and Haemostasis Research Center, Leiden University Medical Center, Leiden, the Netherlands

⁷Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, the Netherlands

› Author Affiliations

Abstract

Summary

The mechanism of air travel-related venous thrombosis is unclear. Although immobility plays a pivotal role, other factors such as fluid loss may contribute. We investigated whether fluid loss occurred more in individuals with coagulation activation after air travel than in subjects without. As a secondary aim, we investigated whether fluid loss per se occurred during air travel. In this crossover study, 71 healthy volunteers were exposed to eight hours of air travel, eight hours immobilization in a cinema, and a daily-life control situation. Markers of fluid loss (haematocrit, serum osmolality and albumin) and of coagulation activation were measured before and after each exposure. The study included ll volunteers with and 55 volunteers without coagulation activation during the flight. The change in parameters of fluid loss was not different in volunteers with an activated clotting system from those without (difference between groups in haematocrit: −0.6%, 95% confidence interval [CI]: −1.9 to 0.6). On a group level, mean haematocrit values decreased during all three exposures. However, in some individuals it increased, which occurred in more participants during the flight (34%; 95% CI 22 to 46) than during the daily-life situation (l9%; 95% CI 10 to 28). These findings do not support the hypothesis that fluid loss contributes to thrombus formation during air travel.

Keywords

Venous thrombosis - hypercoagulability - air travel - fluid loss - dehydration

Full Text

References

References
1 Schwarz T, Siegert G, Oettler W. et al. Venous thrombosis after long-haul flights. Arch Intern Med 2003; 163: 2759-2764.
2 Martinelli I, Taioli E, Battaglioli T. et al. Risk of venous thromboembolism after air travel: interaction with thrombophilia and oral contraceptives. Arch Intern Med 2003; 163: 2771-2774.
3 Kelman CW, Kortt MA, Becker NG. et al. Deep vein thrombosis and air travel: record linkage study. Br Med J 2003; 327: 1072.
4 Stricker H, Colucci G, Godio M. et al. The influence of a prolonged sitting position on the biochemical markers of coagulation activation in healthy subjects: evidence of reduced thrombin generation. J Thromb Haemost 2003; 1: 380-381.
5 Schobersberger W, Mittermayr M, Innerhofer P. et al. Coagulation changes and edema formation during long-distance bus travel. Blood Coagul Fibrinolysis 2004; 15: 419-425.
6 Schreijer AJM, Cannegieter SC, Meijers JC. et al. Activation of coagulation system during air travel: a crossover study. Lancet 2006; 367: 832-838.
7 Ansell JE. Air travel and venous thromboembolism--is the evidence in?. N Engl J Med 2001; 345: 828-829.
8 Moyses C.. Economy class syndrome. Lancet 1988; 332: 1077.
9 Nagda NL, Hodgson M. Low relative humidity and aircraft cabin air quality. Indoor Air 2001; 11: 200-214.
10 de Ree H, Bagshaw M, Simons R. et al. Ozone and relative humidity in airline cabins on popular routes: Measurements and physical symptoms. In: Air Quality and comfort in Airliner Cabins. West Conshohocken: American Society for Testing Materials; 2000: 243-258.
11 Chee YL, Watson HG. Air travel and thrombosis. Br J Haematol 2005; 130: 671-680.
12 Brenner B. Pharmacological prevention of venous thromboembolism before air travel. Is it necessary? Yes. J Thromb Haemost 2006; 4: 2302-2305.
13 Partsch H. Air travel-related deep venous thrombosis. Vienna views. Cardiovasc Surg 2001; 9: 147-149.
14 Caprini JA, Dubow J. Air travel-related deep venous thrombosis. Chicago views. Cardiovasc Surg 2001; 9: 150-153.
15 Mange K, Matsuura D, Cizman B. et al. Language guiding therapy: the case of dehydration versus volume depletion. Ann Intern Med 1997; 127: 848-853.
16 Dill DB, Costill DL. Calculation of percentage changes in volumes of blood, plasma, and red cells in dehydration. J Appl Physiol 1974; 37: 247-248.
17 Singer GG, Brenner BM.. Fluid and Electrolyte Disturbances. In: Harrison's Principles of Internal Medicine. 16th Edition ed.. McGraw-Hill; 2005. .
18 Carruthers M, Arguelles AE, Mosovich A. Man in transit: Biochemical and physiological changes during intercontinental flights. Lancet 1976; 1: 977-981.
19 Simons R, Krol J.. Jet leg, pulmonary embolism, and hypoxia. Lancet 1996; 348: 416.
20 Landgraf H, Vanselow B, Schulte-Huermann D. et al. Economy class syndrome: rheology, fluid balance, and lower leg edema during a simulated 12-hour long distance flight. Aviat Space Environ Med 1994; 65: 930-935.
21 Maher JT, Levine PH, Cymerman A. Human coagulation abnormalities during acute exposure to hypobaric hypoxia. J Appl Physiol 1976; 41: 702-707.
22 Greenleaf JE, Farrell PA, Loomis JL. et al. Sodium chloride-citrate beverages attenuate hypovolemia in men resting 12 h at 2800 m altitude. Aviat Space Environ Med 1998; 69: 936-943.
23 Hamada K, Doi T, Sakura M. et al. Effects of hydration on fluid balance and lower-extremity blood viscosity during long airplane flights. J Am Med Assoc 2002; 287: 844-845.
24 Mittermayr M, Fries D, Innerhofer P. et al. Formation of edema and fluid shifts during a long-haul flight. J Travel Med 2003; 10: 334-339.
25 Schobersberger W, Fries D, Mittermayr M. et al. Changes of biochemical markers and functional tests for clot formation during long-haul flights. Thromb Res 2002; 108: 19-24.
26 Schobersberger W, Mittermayr M, Fries D. et al. Changes in blood coagulation of arm and leg veins during a simulated long-haul flight. Thromb Res 2007; 119: 293-300.
27 Zorbas YG, Yarullin VL, Denogratov SD. et al. Fluid volume measurements in normal subjects to disclose body hydration during acute bed rest. Int Urol Nephrol 2003; 35: 457-465.
28 Ansari MT, Mahmood MT, Karlberg JP. The association between seated immobility and local lower-limb venous coagulability in healthy adult volunteers: a simulation of prolonged travel immobility. Blood Coagul Fibrinolysis 2006; 17: 335-341.
29 Kelly J, Hunt BJ, Lewis RR. et al. Dehydration and venous thromboembolism after acute stroke. QJM 2004; 97: 293-296.
30 Nowak-Gottl U, von Kries R, Gobel U.. Neonatal symptomatic thromboembolism in Germany: two year survey. Arch Dis Child Fetal Neonatal Ed 1997; 76: F163-F167.
31 Pfausler B, Vollert H, Bosch S. et al. Cerebral Venous Thrombosis – A New Diagnosis in Travel Medicine?. J Travel Med 1996; 3: 165-167.
32 Bohler J, Hauenstein KH, Hasler K. et al. Renal vein thrombosis in a dehydrated patient on an oral contraceptive agent. Nephrol Dial Transplant 1989; 4: 993-995.
33 Spivak J. Daily aspirin--only half the answer. N Engl J Med 2004; 350: 99-101.
34 Nicholson A. Dehydration and long haul flights?. Travel Medicine Int 1998; 16: 177-181.
35 Nagashima K, Cline GW, Mack GW. et al. Intense exercise stimulates albumin synthesis in the upright posture. J Appl Physiol 2000; 88: 41-46.

Fluid loss does not explain coagulation activation during air travel[*]

Fluid loss does not explain coagulation activation during air travel^[*]