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 Table of Contents  
COMMENTARY
Year : 2020  |  Volume : 2  |  Issue : 3  |  Page : 47-48

Cerebral Venous Thrombosis in Air Travelers during COVID-19 Times: Is the Risk Higher?


1 Neurology, Paracelsus Medical University, Salzburg, Austria; Department of Neurosurgery, Center of Biomedical Research (CIB), University of Cartagena, Cartagena de Indias, Colombia
2 Neurology, Regions Hospital, Saint Paul, MN, USA
3 Neurology, Paracelsus Medical University, Salzburg, Austria
4 Neurology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India

Date of Submission19-Sep-2020
Date of Acceptance24-Nov-2020
Date of Web Publication31-Dec-2020

Correspondence Address:
Dr. Luis Rafael Moscote-Salazar
Department of Neurosurgery, University of Cartagena, Cra. 50 #24120, Cartagena de Indias

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DOI: 10.4103/jtccm.jtccm_18_20

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How to cite this article:
Moscote-Salazar LR, Janjua T, Bosque-Varela P, Agrawal A. Cerebral Venous Thrombosis in Air Travelers during COVID-19 Times: Is the Risk Higher?. J Transl Crit Care Med 2020;2:47-8

How to cite this URL:
Moscote-Salazar LR, Janjua T, Bosque-Varela P, Agrawal A. Cerebral Venous Thrombosis in Air Travelers during COVID-19 Times: Is the Risk Higher?. J Transl Crit Care Med [serial online] 2020 [cited 2021 Nov 28];2:47-8. Available from: http://www.tccmjournal.com/text.asp?2020/2/3/47/305795



In early 2020, the new coronaviruses or SARS-CoV-2 has been linked to the most recent pandemic.[1] This virus represents a great challenge for health systems worldwide, predominantly respiratory infectious agents leading to fast spread. One of the aspects of the economy that has been profoundly affected is air travel and transport. People who frequently use air transport face various health disorders that include cardiovascular disease, cognitive deficit, jet-lag, and venous thromboembolism, among others.[2] Coronavirus induces a severe phenomenon of the inflammatory response, organic dysfunction, including the development of coagulopathy.[3] Clinical studies have shown a significant number of thrombotic events in Chinese patients. It is important to mention that in the Chinese population, the risk of thrombosis is higher in comparison with Caucasians.[4] In COVID-19 patients, the development of coagulopathy is linked to the severity of the disease stage. Among the abnormalities seen are elevation of D-dimer, increase in prothrombin time and in cases of extreme severity, reduction of fibrinogen levels.

More than 50 years ago, Louvel described a small series of patients who had venous thrombosis after air travel.[5] Kuipers et al., in a study carried out between January 2000 and December 2005, evaluated the occurrence of air travel-associated symptomatic venous thrombosis. This study concluded that there is a moderate risk of venous thrombosis in people who were exposed to more flights in a short time frame. Furthermore, in the same study, the flight duration was associated with increased risk, with longer duration, more risk.[6] The use of oral contraceptives can also be a factor associated with venous thrombosis.[7] Cerebral venous thrombosis is an infrequent pathology.[8] Cases of cerebral venous thrombosis have been reported in patients who have recently been in air travel.[9],[10] It has been established that factors such as alcohol consumption, changes in the concentration of oxygen in the cabin and decreased humidity favors dehydration, ultimately leading to increased blood viscosity and hemoconcentration.[10],[11]

In this letter, we want to highlight the possible risk of the development of cerebral venous thrombosis in patients with SARS-CoV-2 infection due to its procoagulant effect. Given the risk of thrombotic events, and as other authors have suggested, we advocate the use of low molecular weight heparin in patients with a recent history of SARS-CoV-2, mainly on transatlantic flights.[10] In addition, warning signs should be recommended to patients with long-term flights. Research studies in this field are required in the future to determine the real risk of coronavirus infection and coagulopathies in patients using air transport.

Acknowledgments

P. B. V received a predoctoral fellowship from the Fundacion Alfonso Martin Escudero (Spain). The authors have no conflict of interest to declare pertaining to this review.



 
  References Top

1.
Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: A descriptive study. Lancet 2020;395:507-13.  Back to cited text no. 1
    
2.
Wooldridge WE. Medical complications of air travel. Who is at risk? Postgrad Med 1990;87:75-7.  Back to cited text no. 2
    
3.
Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost 2020;18:844-7.  Back to cited text no. 3
    
4.
White RH, Keenan CR. Effects of race and ethnicity on the incidence of venous thromboembolism. Thromb Res 2009;123 Suppl 4:S11-7.  Back to cited text no. 4
    
5.
JACQUES-LOUVEL. Four cases of phlebitis due to air travel. Arch Mal Coeur Vaiss 1951;44:748-9.  Back to cited text no. 5
    
6.
Kuipers S, Cannegieter SC, Middeldorp S, Robyn L, Büller HR, Rosendaal FR. The absolute risk of venous thrombosis after air travel: A cohort study of 8,755 employees of international organisations. PLoS Med 2007;4:e290.  Back to cited text no. 6
    
7.
Martinelli I, Taioli E, Battaglioli T, Podda GM, Passamonti SM, Pedotti P, et al. Risk of venous thromboembolism after air travel – Interaction with thrombophilia and oral contraceptives. Arch Intern Med 2003;163: 2771-4.  Back to cited text no. 7
    
8.
Alvis-Miranda HR, Castellar-Leones SM, Alcala-Cerra G, Moscote-Salazar LR. Cerebral sinus venous thrombosis. J Neurosci Rural Pract 2013;4:427-38.  Back to cited text no. 8
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9.
Grotta JC. Cerebral venous thrombosis-A new diagnosis in travel medicine. J Travel Med 1996;3:137.  Back to cited text no. 9
    
10.
Güngör L, Onar MK. Long-distance air travel: A potential new risk factor for cerebral sinus thrombosis? Cerebrovasc Dis 2007;24:312-4.  Back to cited text no. 10
    
11.
Adi Y, Bayliss S, Rouse A, Taylor RS. The association between air travel and deep vein thrombosis: Systematic review and meta-analysis. BMC Cardiovasc Dis 2004;4:7.  Back to cited text no. 11
    




 

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