Travellers' thrombosis and economy class syndrome: incidence, aetiology and prevention

In this article we review economy class syndrome or travellers' thrombosis as it should be more appropriately described. We review the evidence for and against the existence of this condition. Much of the evidence included in this article has been justifiably criticised but it is the best evidence available to date. We conclude that there is a probable link between thrombosis and long distance travel. However this association is confined to individuals with additional risk factors and fatal pulmonary embolus is very rare. The probable aetiology of this association is prolonged immobilisation in cramped conditions. Other factors are likely to play a minor role. When considering preventative measures, for the majority of individuals the risk is very small. Simple advise can be given with no requirement for additional intervention. Compression stockings should be considered for high-risk patients. In individuals planning prolonged travel with multiple risk factors for thrombosis low dose low molecular weight heparin should be considered. The criteria for defining risk groups remains unclear and we outline our recommendations. There is conflicting evidence with regard to the use of aspirin but considering the latest evidence we do not recommend it.