PubMed · 15868698
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Walter M Robinson. 2004. Ethics for astronauts.. https://pubmed.ncbi.nlm.nih.gov/15868698/
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The history of flight has been strongly influenced by the interplay between physiology and technology. The human body defined the relationship between man and machine--it had to be protected from the cold, bad weather, high altitude, speed and bullets. Technological innovations offered a way to improve on aeroplane safety, and enabled pilots to exceed the limits imposed by physiological constraints. In particular, reconnaissance and bombing missions during World War II, which demanded flight at high altitudes, stimulated intensive scientific research and technological development. This research led to the construction of artificial environments for pilots and ultimately gave rise to space medicine.
In recent years, the association between air travel and the incidence of deep-vein thrombosis or pulmonary embolism has become clearer. Epidemiologic studies reveal an increased relative risk of thromboembolism after flights of more than 8 hours and especially in subjects at higher risk for this disease, due, for example, to congenital thrombophilia or the use of oral contraceptives. However, the absolute risk of deep-vein thrombosis or pulmonary embolism after prolonged air travel is very small. Studies have shown that a combination of factors present during prolonged air travel may account for increased activation of coagulation. There is no definitive proof that elastic stockings are effective in reducing the incidence of clinically relevant thromboembolism during air travel. Acetylsalicylic acid is not effective in the prevention of thrombosis during air travel and may be dangerous. Prophylactic subcutaneous low molecular weight heparin may be effective to prevent air travel-associated thrombosis. However, pending more solid evidence, this strategy should only be used cautiously, e.g. only in patients with a high risk of thrombosis who are planning a long flight.
A recent Cochrane systematic review assessed the effects of wearing compression stockings during long-distance flights on the risk of deep-vein thrombosis (DVT). Ten randomised trials were included, 9 of which compared wearing compression stockings on both legs during the whole flight (at least 7 hours) with not wearing compression stockings. In these 9 trials, 50 of 2637 participants with 1 week of follow-up had asymptomatic DVT; 3 had worn stockings, 47 had not (odds ratio: 0.10; 95% CI: 0.04-0.25). No deaths, pulmonary emboli or symptomatic DVTs were reported. Wearing stockings had a significant impact in reducing oedema of the lower legs. No significant adverse effects of wearing stockings were reported.