As the man sat in the hospital room, a million thoughts raced through his mind. How could this have happened? He had followed all the advice, he had taken precautions, and yet, here he was, diagnosed with a deep venous thrombosis (DVT). He couldn’t understand it. One of the measures he had taken to prevent DVT was wearing lower extremity compression stockings during his flight. He had heard that they were supposed to prevent the occurrence of blood clots in the legs, so why did he develop one?
Hey Ryan-that was in 2016. The quality of evidence is very low. There is data for superficial vein thrombosis which is a manifestation of venous reflux. As you know, superficial vein thrombosis is not related to deep vein thrombosis. If you think about it, logically, even the highest compression 30 to 40 mmHg do nothing related to the deep venous system. Leg squeezers in the hospital do nothing regarding augmenting blood flow in their prevention of DVT. I know this is contrary to what most physicians think. They stimulate an endothelial relaxant factor. That’s why they work if you put them on the arm. The real reason to wear compression stockings on an airplane is because it does reduce edema in people who have superficial or deep vein reflux, and therefore reduces the acute manifestations....tired, heavy, painful, swollen legs at the end of a long flight. It’s the same reason why I tell people you should wear compression stockings if you have documented reflux and sit at the desk all day. The only way blood gets back to your heart is via walking or elevating your legs. The main thing to do when flying is to Montana stay very well hydrated and do some leg and feet exercises if they won’t let you walk up and down the aisle. In addition, if they have any family members that have unprovoked DVT, they should have a clotting workup definitely including a Factor V deficiency.
Nov 19, 2023Liked by Michael Richman MD, MMM, FACS
Hi! Interesting take on this, as I respect your expertise in this subject matter. However I did a recent post and cited a meta-analysis quoted by an UpToDate article on passenger safety on airplanes. In this environment it seems that there is a substantial reduction in DVT risk in those wearing compression stockings (symptom free/occult Dvt especially:
Hey Ryan-that was in 2016. The quality of evidence is very low. There is data for superficial vein thrombosis which is a manifestation of venous reflux. As you know, superficial vein thrombosis is not related to deep vein thrombosis. If you think about it, logically, even the highest compression 30 to 40 mmHg do nothing related to the deep venous system. Leg squeezers in the hospital do nothing regarding augmenting blood flow in their prevention of DVT. I know this is contrary to what most physicians think. They stimulate an endothelial relaxant factor. That’s why they work if you put them on the arm. The real reason to wear compression stockings on an airplane is because it does reduce edema in people who have superficial or deep vein reflux, and therefore reduces the acute manifestations....tired, heavy, painful, swollen legs at the end of a long flight. It’s the same reason why I tell people you should wear compression stockings if you have documented reflux and sit at the desk all day. The only way blood gets back to your heart is via walking or elevating your legs. The main thing to do when flying is to Montana stay very well hydrated and do some leg and feet exercises if they won’t let you walk up and down the aisle. In addition, if they have any family members that have unprovoked DVT, they should have a clotting workup definitely including a Factor V deficiency.
Hi! Interesting take on this, as I respect your expertise in this subject matter. However I did a recent post and cited a meta-analysis quoted by an UpToDate article on passenger safety on airplanes. In this environment it seems that there is a substantial reduction in DVT risk in those wearing compression stockings (symptom free/occult Dvt especially:
https://pubmed.ncbi.nlm.nih.gov/27624857/