Symptomatic travel associated pulmonary embolism: high severity does not imply poor long term prognosis

Abstract

As air travel has become increasingly popular during the last two decades, the death of a 27-year-old woman in the Arrivals Hall at Heathrow Airport after a 20 h flight triggered an important number of medical investigations that aimed to clarify the epidemiology, physiopathology, and associated risk factors of the so-called ‘economy class syndrome’ in order to support the evaluation of preventive strategies. Indeed, given the large number of people travelling long distances around the world, strategies intended for travel-associated venous thrombo-embolism (VTE) prevention must reach a high level of scientific quality, demonstrating safety and high effecacy. Therefore, such strategies should primarily focus on those patients with the highest risk of serious adverse outcomes associated with travel-related VTE. Unfortunately, despite a large amount of medical literature, several important features related to this issue remain under debate, and preventive strategies are still poorly documented, and mostly based on general precautions that might be helpful and harmless in preventing deep vein thrombosis (DVT).1–3 Therefore, there is a great interest in identifying those patients with the highest risk of developing travel-associated VTE, namely those presenting with symptomatic pulmonary embolism (PE). Indeed, the risk to travellers has to be balanced against potential adverse events associated with more aggressive preventive strategies such as low molecular weight heparin. In this perspective, the study published by Lehmann et al. 4 has original features that have added important insights to our knowledge of travel-associated symptomatic PE, which is the most threatening and therefore the most clinically relevant category of VTE. The authors compared clinical characteristics and the long-term prognosis of two groups of patients referred to hospital for the treatment of travel-associated or non-travel-associated PE. In 1856, Virchow first reported that … *Corresponding author. Tel: +33 1 49 81 25 23, Fax: +33 1 49 81 29 87, Email: bertrand.renaud{at}hmn.aphp.fr