title: Coagulation changes and edema formation during long-distance bus travel.
abstract: Long-distance travel in a cramped position by aircraft or by bus and car has been suggested to be associated with an increased risk for thromboembolic events. Recently, we demonstrated moderate activation of coagulation after a long-haul flight. At present the single contributing factors (i.e. hypoxia and low humidity on board an aircraft and prolonged sitting in an aircraft, car or bus inducing venous stasis) have not yet been investigated. Therefore we measured markers of coagulation and fibrinolysis as well as functional parameters of coagulation using activated thrombelastography in 19 healthy volunteers before, during and after a real 10-h bus journey. In addition, changes in leg volume were measured. Thrombelastography revealed moderate activation of coagulation in all travelers, which was accompanied by a significant increase in prothrombin fragment F1 + 2. Thrombin-antithrombin III complexes and D-dimer remained unchanged, and tissue-type plasminogen activator and plasminogen-activator inhibitor 1 decreased after travel. After the travel we found a significant increase in leg volume that was exclusively distributed in the calf. We conclude that beside long-haul flights also long-distance bus travel induces a certain activation of the coagulation system. Thus, it is questionable whether hypoxia is the crucial risk factor for thromboembolic events after long-haul flights.
authors.affiliation: University for Health Sciences, Medical Informatics and Technology Tyrol, Institute for Leisure, Travel and Alpine Medicine, Innsbruck, Austria. wolfgang.schobersberger@umit.at
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Schobersberger
authors.forename: Markus
authors.initials: M
authors.lastname: Mittermayr
authors.forename: Petra
authors.initials: P
authors.lastname: Innerhofer
authors.forename: Guenther
authors.initials: G
authors.lastname: Sumann
authors.forename: Beatrix
authors.initials: B
authors.lastname: Schobersberger
authors.forename: Anton
authors.initials: A
authors.lastname: Klingler
authors.forename: Markus
authors.initials: M
authors.lastname: Simmer
authors.forename: Werner
authors.initials: W
authors.lastname: Streif
authors.forename: Uwe
authors.initials: U
authors.lastname: Fischbach
authors.forename: Dietmar
authors.initials: D
authors.lastname: Fries
mesh_terms: D000401:Aircraft; D000990:Antithrombin III / Q000032:analysis; D001777:Blood Coagulation / Q000502:physiology*; D001779:Blood Coagulation Factors / Q000032:analysis; D004487:Edema / Q000097:blood* / Q000209:etiology; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D005342:Fibrinolysis / Q000502:physiology*; D006801:Humans; D000860:Hypoxia / Q000097:blood / Q000150:complications / Q000209:etiology; D007866:Leg / Q000098:blood supply; D018986:Motor Vehicles; D013916:Thrombelastography; D013923:Thromboembolism / Q000097:blood / Q000209:etiology; D014195:Travel
chemical_list: D001779:Blood Coagulation Factors; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D; D000990:Antithrombin III