Early Online

• Published in: South African medical journal Vol. 114; no. 7; p. e2109
• Main Authors: Jacobson, B F, Louw, S, Schapkaitz, E, Laher, F
• Format: Journal Article
• Language: English
• Published: South Africa South African Medical Association 19.07.2024
• Subjects: Adult; aetiology; Air Travel; Altitude; aviation; Female; Fibrin Fibrinogen Degradation Products - analysis; Fibrin Fibrinogen Degradation Products - metabolism; flying; Healthy Volunteers; Humans; Male; Middle Aged; Oximetry; Risk Factors; Thrombelastography; thrombosis; Thrombosis - etiology; Thrombosis - prevention & control; von Willebrand Factor - analysis; von Willebrand Factor - metabolism
• ISSN: 0256-9574; 2078-5135
• DOI: 10.7196/SAMJ.2024.v114i9.2109

Long-haul flights have been associated with a two- to four-fold increased risk of aviation-related thrombosis (ART). Several studies have investigated the extent to which hypoxic hypobaric exposure, dehydration and prolonged immobilisation during air travel induce changes in haemostasis. To investigate the role of high altitude as a risk factor for ART. Healthy volunteers aged ≥18 years (N=40), without risk factors for venous thromboembolism, were exposed to an exacerbated altitude of 18 000 feet (5 486 m) for 1 hour. During the flight, the oxygen (O2) levels of the participants, who received supplemental O2, were measured by pulse oximetry and maintained at >92%. Venous blood and urine samples were collected prior to departure and immediately after flying in an unpressurised twin-engine airplane. D-dimer levels, thromboelastography (TEG) parameters, von Willebrand factor (VWF) activity and urine osmolality were measured. The participants were 19 men and 21 women, with a mean (standard deviation) age of 46 (14) years. A significant difference in D-dimer levels, VWF activity, urine osmolality and TEG parameters (reaction (R) time, kinetic (K) time and maximum amplitude (MA)) before and after the 1-hour flight was observed (p<0.001). Urine osmolality correlated positively with VWF activity levels (r=0.469; p<0.002). Air travel at high altitude induced a hypercoagulable state in healthy volunteers. Future research should focus on whether thromboprophylaxis can significantly obviate the activation of coagulation in response to high altitude.