Heart defect could add to 'economy class' clot danger

Researchers say the small opening between the heart's chambers, called a patent foramen ovale (PFO), provides a passageway for blood clots from the right side of the heart to the arteries that lead to the brain. They estimate that 30% of the population has this asymptomatic opening, which in most people closes after birth.

The American Academy of Neurology study adds another degree of danger to deep vein thrombosis (DVT), a condition in which blood clots form in the legs after long periods of inactivity. DVT has been nicknamed economy class syndrome because airline passengers have suffered clots after long flights.

TAKE STEPS TO REDUCE RISK If you travel long distances by air, you should take common-sense measures to reduce the likelihood of blood clots," says Stephen Borron, associate clinical professor of emergency medicine at George Washington University in Washington, D.C. Experts recommend the following preventive measures to reduce the risk of deep vein thrombosis: Stay well hydrated; avoid caffeine and alcoholic beverages. Starting three days before the flight, take one aspirin a day. Move around periodically; take a walk in the aisle. While seated, flex your ankles, pump and massage your legs. Wear compression stockings that prevent blood from pooling in your legs.

Though most clots dissolve in the bloodstream, those that don't can lodge in the legs, causing swelling, pain and redness. In rare and sometimes fatal cases, a clot travels to the lungs, lodges in an artery and mimics a heart attack with symptoms like shortness of breath and chest pain.

"Blood clots coming from the legs that make their way to the brain are the rarest case, and can only occur if a person has a PFO," said Stephen Borron, associate clinical professor of emergency medicine at George Washington University in Washington, D.C., and the study's author. Passengers who frequently travel long distances or know they're at higher risk for blood clots can receive a PFO test as part of routine cardiovascular tests.

For eight years, researchers studied passengers who arrived at Charles de Gaulle Airport in Paris after long flights. A very small percentage had a stroke caused by a blood clot but even so, each person in that small group had a PFO.

Experts estimate there are several hundred cases of DVT each year, but because most passengers don't seek treatment until days after flying, they're often misdiagnosed, which leaves the actual number unclear. Most passengers don't even know DVT exists — 75% of Americans, in fact, according to a study this year by the American Public Health Association and Centers for Disease Control and Prevention.

That was true for Shawn Blansett, who two years ago took a long nap on a flight from Houston to London. Neither he nor his wife, Modesta, was aware of DVT or that Shawn, 36 at the time, had a PFO.

Four hours into the flight, Blansett woke up to see the cabin spinning, the result, doctors say, of a blood clot that had traveled from his leg to his brain. He was rushed to a hospital in London, where doctors were forced to remove a portion of his cerebellum, the part of the brain responsible for coordination.

The father of two was left permanently disabled. He and his wife have filed a lawsuit against Continental Airlines claiming that they, and other passengers, weren't warned about the risks of DVT.

"What the general population needs to know is that ... they need to try and prevent these blood clots regardless of age or cardiovascular condition," said neurologist Edgar Kenton, chief of cerebral vascular diseases at Thomas Jefferson University in Wynnewood, Pa.

Blood clots can form after prolonged periods of immobility anywhere, not just on planes. Complications of DVT claimed the life of NBC's David Bloom in April. He had been sitting in an armored vehicle for hours at a time covering the war in Iraq.

SOURCE: By Arianne Aryanpur, USA TODAY, Copyright 2003 USA TODAY, a division of Gannett Co. Inc. Posted 6/24/2003 1:02 AM     Updated 6/24/2003 1:04 AM

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