Gender as a risk factor for pulmonary embolism after air travel

Frédéric Lapostolle; Philippe Le Toumelin; Carine Chassery; Michel Galinski; Lydia Ameur; Patricia Jabre; Claude Lapandry; Frédéric Adnet

doi:10.1160/TH09-06-0407

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2009; 102(06): 1165-1168
DOI: 10.1160/TH09-06-0407

Rapid and Short Communication

Schattauer GmbH

Gender as a risk factor for pulmonary embolism after air travel

Authors

Frédéric Lapostolle

¹SAMU 93, Hôpital Avicenne, Bobigny Cedex, France
Philippe Le Toumelin

¹SAMU 93, Hôpital Avicenne, Bobigny Cedex, France
Carine Chassery

¹SAMU 93, Hôpital Avicenne, Bobigny Cedex, France
Michel Galinski

¹SAMU 93, Hôpital Avicenne, Bobigny Cedex, France
Lydia Ameur

¹SAMU 93, Hôpital Avicenne, Bobigny Cedex, France
Patricia Jabre

¹SAMU 93, Hôpital Avicenne, Bobigny Cedex, France
Claude Lapandry

¹SAMU 93, Hôpital Avicenne, Bobigny Cedex, France
Frédéric Adnet

¹SAMU 93, Hôpital Avicenne, Bobigny Cedex, France

Abstract

Summary

It was the objective of this study to confirm the hypothesis that women experience an increased risk of pulmonary embolism (PE) and/or thromboembolic events after long-distance air travel. We systematically reviewed the records of all patients with confirmed pulmonary embolism after arrival at Roissy-Charles-de-Gaulle (CDG) Airport (Paris, France) during a 13-year period.The incidence of PE was calculated as a function of distance travelled and gender using Bayesian conditional probabilities obtained in part from a control population of long-distance travellers arriving in French Polynesia (Tahiti). A total of 287.6 million passengers landed at CDG airport during the study period. The proportion of male to female long-distance travellers was estimated to be 50.5% to 49.5%. Overall, 116 patients experienced PE after landing [90 females (78%), 26 males (22%)]. The estimated incidence of PE was 0.61 (0.61–0.61) cases per million passengers in females and 0.2 (0.20–0.20) in males, and reached 7.24 (7.17–7.31) and 2.35 (2.33–2.38) cases, respectively, in passengers travelling over 10,000 km. Our study strongly suggests that there is a relationship between risk of PE after air travel and gender.This relationship needs to be confirmed in order to develop the best strategy for prophylaxis.

Keywords

Pulmonary embolism - risk factors - clinical studies

Full Text

References

References
1 Brenner B. Prophylaxis for travel-related thrombosis? Yes. J Thromb Haemost 2004; 2: 2089-2091.
2 Lubetsky A. Prophylaxis for travel-related thrombosis? No. J Thromb Haemost 2004; 2: 2092-2093.
3 Symington IS, Stack BH. Pulmonary thromboembolism after travel. Br J Dis Chest 1977; 71: 138-140.
4 Lapostolle F, Surget V, Borron SW. et al. Severe pulmonary embolism associated with air travel. New Engl J Med 2001; 345: 779-783.
5 Morio H, Fujimori Y, Terasawa K. et al. Pulmonary thromboembolism associated with air travel in Japan. Circ J 2005; 69: 1297-1301.
6 Pérez-Rodríguez E, Jiménez D, Díaz G. et al. Incidence of air travel-related pulmonary embolism at the Madrid-Barajas airport. Arch Intern Med 2003; 163: 2766-2770.
7 Nordström M, Lindblad B, Bergqvist D. et al. A prospective study of the incidence of deep-vein thrombosis within a defined urban population. J Intern Med 1992; 232: 155-156.
8 Anderson Jr FA, Wheeler HB, Goldberg RJ. et al. A population-based perspective of the hospital incidence and case-fatality rates of deep vein thrombosis and pulmonary embolism. The Worcester DVT Study. Arch Intern Med 1991; 151: 933-938.
9 White RH. The epidemiology of venous thromboembolism. Circulation 2003; 107 Suppl I I-4-I-8.
10 Rosendaal FR, Van Hylckama Vlieg A, Tanis BC. et al. Estrogens, progestogens and thrombosis. J Thromb Haemost 2003; 1: 1371-1380.
11 Virchow RLK. Gesammelte Abhandlungen zur wissenschaftlischen Medicin. In Thrombosis and emboli. Frankfurt Meidinger Sohn & Co; 1856: 219-732.
12 Schreijer AJ, Cannegieter SC, Meijers JC. et al. Activation of coagulation system during air travel: a crossover study. Lancet 2006; 367: 832-838.
13 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.
14 Cannegieter SC, Doggen CJ, van Houwelingen HC. et al. Travel-related venous thrombosis: results from a large population-based case control study (MEGA study). PLoS Med 2006; 3: e307.
15 Beebe-Dimmer JL, Pfeifer JR, Engle JS, Schottenfeld D. The epidemiology of chronic venous insufficiency and varicose veins. Ann Epidemiol 2005; 15: 175-184.
16 Kyrle PA, Eichinger S. Deep vein thrombosis. Lancet 2005; 365: 1163-1174.
17 World Health Organization. Travel by air: considerations. 2005; 80: 81-92.
18 Clarke M, Hopewell S, Juszczak E. et al. Compression stockings for preventing deep vein thrombosis in airline passengers. Cochrane Database Syst Rev 2006; 2: CD004002.
19 Schobersberger W, Toff WD, Eklöf B. et al. Traveller’s thrombosis: guidelines for prevention from a consensus conference. Vasa 2008; 37: 311-317.
20 Blomkalns AL, Chen AY, Hochman JS. et al. CRUSADE Investigators. Gender disparities in the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes: large-scale observations from the CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the American College of Cardiology/American Heart Association Guidelines) National Quality Improvement Initiative. J Am Coll Cardiol 2005; 45: 832-837.