THrombosis AETiology of Aviation-Related Travel: The THETA θ study
Background. Long-haul flights have been associated with a two- to four-fold increased risk of aviation-related thrombosis (ART). Several studies have investigated the extent to which hypoxic hypobaric exposure, dehydration and prolonged immobilisation during air travel induce changes in haemost...
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South African Medical Association
2024-09-01
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| Series: | South African Medical Journal |
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| Online Access: | https://samajournals.co.za/index.php/samj/article/view/2109 |
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| author | B F Jacobson S Louw E Schapkaitz F Laher |
| author_facet | B F Jacobson S Louw E Schapkaitz F Laher |
| author_sort | B F Jacobson |
| collection | DOAJ |
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Background. Long-haul flights have been associated with a two- to four-fold increased risk of aviation-related thrombosis (ART). Several studies have investigated the extent to which hypoxic hypobaric exposure, dehydration and prolonged immobilisation during air travel induce changes in haemostasis.
Objective. To investigate the role of high altitude as a risk factor for ART.
Methods. Healthy volunteers aged ≥18 years (N=40), without risk factors for venous thromboembolism, were exposed to an exacerbated altitude of 18 000 feet (5 486 m) for 1 hour. During the flight, the oxygen (O2) levels of the participants, who received supplemental O2, were measured by pulse oximetry and maintained at >92%. Venous blood and urine samples were collected prior to departure and immediately after flying in an unpressurised twin-engine airplane. D-dimer levels, thromboelastography (TEG) parameters, von Willebrand factor (VWF) activity and urine osmolality were measured.
Results. The participants were 19 men and 21 women, with a mean (standard deviation) age of 46 (14) years. A significant difference in D-dimer levels, VWF activity, urine osmolality and TEG parameters (reaction (R) time, kinetic (K) time and maximum amplitude (MA)) before and after the 1-hour flight was observed (p<0.001). Urine osmolality correlated positively with VWF activity levels (r=0.469; p<0.002).
Conclusion. Air travel at high altitude induced a hypercoagulable state in healthy volunteers. Future research should focus on whether thromboprophylaxis can significantly obviate the activation of coagulation in response to high altitude.
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| format | Article |
| id | doaj-art-c11c406fb6d142ce8b13ef310659be02 |
| institution | Kabale University |
| issn | 0256-9574 2078-5135 |
| language | English |
| publishDate | 2024-09-01 |
| publisher | South African Medical Association |
| record_format | Article |
| series | South African Medical Journal |
| spelling | doaj-art-c11c406fb6d142ce8b13ef310659be022025-02-10T12:25:41ZengSouth African Medical AssociationSouth African Medical Journal0256-95742078-51352024-09-01114910.7196/SAMJ.2024.v114i9.2109THrombosis AETiology of Aviation-Related Travel: The THETA θ studyB F Jacobson0S Louw1E Schapkaitz2https://orcid.org/0000-0002-1534-2930F Laher3National Health Laboratory Service and Department of Haematology and Molecular Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South AfricaNational Health Laboratory Service and Department of Haematology and Molecular Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South AfricaNational Health Laboratory Service and Department of Haematology and Molecular Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South AfricaNational Health Laboratory Service and Department of Haematology and Molecular Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa Background. Long-haul flights have been associated with a two- to four-fold increased risk of aviation-related thrombosis (ART). Several studies have investigated the extent to which hypoxic hypobaric exposure, dehydration and prolonged immobilisation during air travel induce changes in haemostasis. Objective. To investigate the role of high altitude as a risk factor for ART. Methods. Healthy volunteers aged ≥18 years (N=40), without risk factors for venous thromboembolism, were exposed to an exacerbated altitude of 18 000 feet (5 486 m) for 1 hour. During the flight, the oxygen (O2) levels of the participants, who received supplemental O2, were measured by pulse oximetry and maintained at >92%. Venous blood and urine samples were collected prior to departure and immediately after flying in an unpressurised twin-engine airplane. D-dimer levels, thromboelastography (TEG) parameters, von Willebrand factor (VWF) activity and urine osmolality were measured. Results. The participants were 19 men and 21 women, with a mean (standard deviation) age of 46 (14) years. A significant difference in D-dimer levels, VWF activity, urine osmolality and TEG parameters (reaction (R) time, kinetic (K) time and maximum amplitude (MA)) before and after the 1-hour flight was observed (p<0.001). Urine osmolality correlated positively with VWF activity levels (r=0.469; p<0.002). Conclusion. Air travel at high altitude induced a hypercoagulable state in healthy volunteers. Future research should focus on whether thromboprophylaxis can significantly obviate the activation of coagulation in response to high altitude. https://samajournals.co.za/index.php/samj/article/view/2109flyingaviationthrombosisaetiology |
| spellingShingle | B F Jacobson S Louw E Schapkaitz F Laher THrombosis AETiology of Aviation-Related Travel: The THETA θ study South African Medical Journal flying aviation thrombosis aetiology |
| title | THrombosis AETiology of Aviation-Related Travel: The THETA θ study |
| title_full | THrombosis AETiology of Aviation-Related Travel: The THETA θ study |
| title_fullStr | THrombosis AETiology of Aviation-Related Travel: The THETA θ study |
| title_full_unstemmed | THrombosis AETiology of Aviation-Related Travel: The THETA θ study |
| title_short | THrombosis AETiology of Aviation-Related Travel: The THETA θ study |
| title_sort | thrombosis aetiology of aviation related travel the theta θ study |
| topic | flying aviation thrombosis aetiology |
| url | https://samajournals.co.za/index.php/samj/article/view/2109 |
| work_keys_str_mv | AT bfjacobson thrombosisaetiologyofaviationrelatedtravelthethetathstudy AT slouw thrombosisaetiologyofaviationrelatedtravelthethetathstudy AT eschapkaitz thrombosisaetiologyofaviationrelatedtravelthethetathstudy AT flaher thrombosisaetiologyofaviationrelatedtravelthethetathstudy |