Venous thromboembolism during air travel: does the existing evidence raise legal implications?
Venous thromboembolism associated with prolonged sitting during air travel has been reported in the medical literature. The aim of this article was to review whether the existing evidence can raise ethical concerns and grounds for legal implications. Review of the pertinent literature. Long duration air travel is linked with venous thromboembolism in susceptible individuals. However, the jurisdictions in countries that have adopted the Warsaw Convention 1929 and its amendment at Hague in 1955 have invariably based their approach on whether venous thromboembolism developed after air travel is an "accident" under the provision of article 17. Not only this has failed to be proven under various jurisdictions but also inaction, including not warning of the risk and not giving advice on the precautions that would minimise that risk have not been considered sufficient to rank venous thromboembolism as an "accident". While there is scientific evidence to support that long-haul flights may predispose to the development of venous thromboembolism in susceptible individuals, there is a clear trend in various jurisdictions that the airline carrier does not incur liability under the Warsaw convention. Nevertheless, the existing scientific evidence raises ethical concerns on the need for information and advice on prevention to those passengers at risk from the airline companies. [Int Angiol 2009;28:269-73]