December 9, 2023December 9, 2023 by Lily Jacobs

Journal Article

Long-haul flights, edema, and thrombotic events: prevention with stockings and Pycnogenol® supplementation (LONFLIT Registry Study)

The association between immobilization and an increased risk of hypercoagulability is a critical concern. Prolonged immobilization decreases muscle contraction leading to decreased blood flow, blood stasis, and eventually the formation of blood clots. Majority of the time, any blood clot that is formed may resolve on its own; however, the longer the person is immobile, the greater risk the patient may be to serious medical conditions such as deep vein thrombosis (DVT) or superficial thrombophlebitis. According to the WHO, long distance traveling, defined as 4 hours or more either by ground or air, has been found to with increase the risk of DVT by 2-4-fold. Overall, the risk for travel associated DVT is small, especially in healthy people, and mostly occurs in people with other risk factors (e.g obesity, older age, recent surgery, estrogen contraceptives, pregnancy, varicose veins, active cancer etc.) Unless the individual is at risk for hypercoagulation and need to receive prophylaxis medical treatment, most individuals can benefit from graduated compression stockings. Studies have found that compressions stockings as substantially decrease the risk for DVT and reduce lower extremity edema.

In a 2018 comparative study, researchers aimed to determine the effects of Pycnogenol on leg edema and thrombotic complications on long-haul flights, compared to compression stockings. 295 individuals flying in economy twice a week for a total of more than 8 hours were included and subdivided according to their DVT risk level (e.g low, moderate, or high). The 3 groups either received the control, Pycnogenol, or stockings. Any individuals that had severe bone/joint conditions, diabetes mellites, severe hypertension, obesity, recent thrombosis in the last 6 months, or an increased d-dimer level before the flight were excluded from the sample. Lower extremity edema was measured via Ankle circumference and d-dimer was used for thrombosis detection. Results showed that across all risk groups, individuals who received Pycnogenol had the lowest edema formation, compared to the control and stocking group, and no one had a positive d-dimer. Among the low-risk, the control had 1 positive d-dimer and the stocking group had 2 positive d-dimer. In the moderate-risk and high-risk individuals, 1 DVT and 1 SVT were seen in the controls. As a secondary outcome, researchers also measured jet lag and found that jet lag scores were lower in Pycnogenol subjects across all risk groups, compared to the other groups.

Though a larger study is needed to further solidify the results of this study, these findings highlight the potential benefits of Pycnogenol, a natural compound from a French pine bark, and its comparable efficacy if not more to compression stockings in reducing edema of the legs, reducing the incidence of DVTs during long flights, without associated side effects. Other studies have also shown that it may have long-term protective efficacy individuals following a thrombotic event. Future studies should concentrate on how much supplementation is needed and if there are any long-term effects, especially among individuals with comorbidities and on other medications.

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