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June 12, 2007

Warnings to Beckham about "economy class syndrome"

Not suggesting that David Beckham would be traveling in economy class when he does his trans-global commute between the England and US soccer teams. This BBC News report quotes an authority who feels it necessary to provide a warning to Beckham:

And aviation health expert Farrol Kahn warned: "It puts him in the high risk category for getting deep-vein thrombosis (DVT).

"That would ruin that leg for life - you simply could not use it again."

Beckham will also struggle to be at his physical and mental peak for England and Galaxy games in the immediate aftermath of long flights, according to Kahn.

Kahn told BBC Sport: "They've done studies of rapid deployment forces in the US military who have to fly long distances and then fight.

"In these young males, sprint times were reduced by 10%, lift and carry tasks by 9% and logical reasoning skills by 15%."

I tried to find the study cited about the military, but no luck. The phrase, "would ruin that leg for life," is not quite a medical assessment, besides, the worst sequelae of a DVT would be the fatal pulmonary embolism (PE), not mentioned by this expert.

This animation by Nucleus Medical Art demonstrates the creation of a clot just behind a valve in one of the deep leg veins, then the clot breaks loose and travels to the right side of the heart where it is sent into one of the lung blood vessels where it lodges and causes the fatal reaction known as a PE.

Coincidentally, I found this recent report, "Doctors Unite in Their Fight Against Economy Class Syndrome," which quotes experts at the 12th Congress of the European Hematology Association which just concluded its annual meeting in Vienna.

A recent WHO project (the WRIGHT, or WHO Research Into Global Hazards of Travel, project), the results of which are about to be made public, has shown that air travel is associated with a two- to threefold increased risk of developing blood clots in the legs, (deep vein thrombosis or DVT) or in the lungs (pulmonary embolism or PE).

The WRIGHT project included a study of nearly 2,000 patients with thrombosis and a survey of 9,000 frequent travelers. Among its conclusions, says Professor Rosendaal, is that in the eight weeks after a flight of more than four hours, the risk of thrombosis is increased two- to threefold. Overall, one in 4500 travelers develops thrombosis. For those individuals with a combination of common risk factors, such as oral contraceptive use and excess weight, the risk of developing blood clots after air travel may increase 100 fold. Professor Rosendaal: "Studies which  ncluded an experimental flight with volunteers showed clearly that immobility of passengers on long flights is the main cause of blood clots, but that cabin conditions such as low air pressure may also contribute."

Rosendaal is quoted:

"The risks of developing thrombosis when traveling are higher for people with certain common abnormalities in the blood, for women who use birth control pills, or people who use sleeping pills on a flight, as well as for people who are very tall, very short, or overweight."

I don't know if Beckham should consider being screened for a coagulopathy such as Factor V Leiden deficiency which is the most common hereditary coagulation disorder in the US, with a prevalence of about 5% in the Caucasian population.

This medical genetic testing Web site associated with the University of New Mexico, give the indications for testing in an article from 1997:

Who should be tested?  Indications include:

  • Venous thrombosis or pulmonary embolism
  • Transient ischemic attacks or premature stroke
  • Peripheral vascular disease, particularly lower extremity occlusive disease
  • History of a thrombotic event
  • Family history of thrombosis or known factor V mutation in a relative
  • Prior to major surgery, pregnancy, postpartum, oral contraceptive use or estrogen therapy if there is a personal or family history of thrombosis.
  • Previous finding of activated protein C resistance by laboratory analysis

Notice that it doesn't mention anticipated long-term commute via aircraft across continents.

Another interesting list about the prevalence of genetic disorders in those who have had a venous thrombotic event:

Genetic Disorder

Prevalence among patients
with venous thrombosis
Factor V mutation (APC resistance) 20-40%
Protein S deficiency 5-6%
Protein C deficiency 2-5%
Antithrombin III deficiency 2-4%
Plasminogen deficiency 1-2%
Heparin cofactor II deficiency <1%
Unknown genetic defects ~40%


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