What is 'economy class syndrome' and how did it take a mother’s life returning from Hawaii?

A slip on some tiles near a pool brought a halt to Melbourne mum Anna Bowditch’s holiday fun in Hawaii. But neither Bowditch nor her husband Steve could have suspected that the slip would set off a chain of events that would eventually result in her death.

The poolside slip, in 2014, left Bowditch with a broken leg. She flew back to Australia with her leg in a cast, propped up on her young daughter Natalia’s fold-down meal table. About a week after arriving back in Australia, Bowditch had surgery on her leg, but there were complications. She died a few days later, following a stroke believed to have been caused by a clot in her brain.

According to a report in The Age, it’s believed that the flight from Hawaii caused Bowditch to develop deep vein thrombosis – also known as economy class syndrome – which involves blood clots forming in the legs.

A coronial inquest into Bowditch’s death will be held next month. Her family are suing her Australian orthopaedic surgeon and anaesthetist, saying they should have taken DVT into consideration before they operated.

The family’s lawyer, Tom Ballantyne from Maurice Blackburn, told The Age that Bowditch had so many of the risk factors for DVT.

“I would say that’s something that is pretty well accepted by everyone involved in the case,” he said.
The doctors involved in the case declined to comment to The Age.

A link  between long-distance flights and DVT was first suggested decades ago. It’s regularly made the news over the years.

In 2014, 32-year-old UK woman Liz Cooper  died just three hours after stepping off a flight from the Canary Islands. Celebrities aren’t immune, either. In 2011, tennis player Serena Williams was hospitalised with a pulmonary embolism believed to have been caused by DVT.


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In 2015, an inquest was held in South Australia into the deaths of two people, Philip Byrne and Jacqueline Weaver, from DVT. The inquest recommended that more consideration should be given to long-distance flights as a risk factor.

Melbourne GP Dr Nick Carr says DVT is “quite common.”

“It happened to a friend of mine who got pulmonary emboli after a long-haul flight and it could have killed him,” he tells Mamamia.

Dr Carr says there are several groups of people that are at higher risk. These include anyone has recently had an operation on their leg, leaving it immobilised.

“So that’s where [Anna Bowditch] was at risk, because her leg was in plaster,” he adds.

Smokers, women on the contraceptive pill, people who are obese and people with cancer are also at higher risk. As well, the risk increases with age.

Anna Bowditch. Image via Facebook.

But is the term “economy class syndrome” accurate? Are people in the cheap seats really in greater danger of developing DVT?

“No one quite knows whether ‘economy class syndrome’ is really real, but there’s a theoretical idea that sitting cramped up in the back of the plane is more risky than with your legs up in more luxury when you’re in the front,” Dr Carr explains.


He says people travelling long distances in buses, trains and cars are also at risk, if the trip involves sitting still for more than three or four hours.

Dr Carr says travellers should take sensible precautions. They shouldn’t let themselves get dehydrated by drinking alcohol, and they shouldn’t take sleeping tablets which will leave them “comatose”.

“Moving your legs around keeps the clots away,” he adds.

Dr Carr says he wears compression socks on long flights, “which have been proven to reduce risk”.

Someone who is at very high risk of developing DVT – for example, a smoker who has recently had an operation on their lower leg – can take extra precautions.

“They should actually consult a doctor and get a blood-thinning injection before they travel,” Dr Carr advises.

A clot that has been formed in the leg can break off and move to another part of the body for up to three or four weeks after a long-distance flight. That means people who have just got off a long flight should keep an eye out for warning signs of clots in the leg. Signs include pain in the calf muscle and swelling of the ankle.

“If you’ve got a painful calf and a swelling in one ankle, particularly if you’re in a high-risk group, you need to get to the doctor and say, ‘I might have a blood clot,’” Dr Carr says.

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