Holiday Thrombosis

ABSTRACT

The pathogenesis of acute thrombosis, either arterial or venous, is typically multifactorial and involves a variety of factors that may be considered relatively “innocuous” when present alone. When someone is unlucky enough to accumulate several risk factors, compounded in many cases by one or more acute triggers, that person may be propelled over a threshold that precipitates the development of an acute episode of thrombosis. There is now reliable evidence that acute thromboses (both venous thromboembolism and acute coronary syndrome) follow a typical seasonal pattern and particularly display a characteristic spike during holiday periods. Overindulgence and abrupt changes of several lifestyle habits have been described as potential precipitating factors during such periods. Long travels, unhealthy diet, excessive or binge drinking and eating, decreased or increased physical activity, emotional and psychological stress, might all variably contribute to trigger an acute thrombotic event. Although the real causes of this “holiday phenomenon” remain speculative as yet, there is a widespread perception that they might represent preventable events like several other risk factors of both venous and arterial thrombosis. Beside drastic and unrealistic measures, such as canceling such holidays from the calendar, it seems reasonable to at least provide advice to patients about these “dangers,” especially those individuals believed to be carrying a higher risk. Many (if not all) patients may ignore such advice and carry on regardless, but they should be given the benefit of informed choice.

KEYWORDS

Holiday - vacation - thrombosis - acute coronary syndrome - myocardial infarction - venous thromboembolism

REFERENCES

• 1 Kloner R A. Can we trigger an acute coronary syndrome?.  Heart. 2006;  92 (8) 1009-1010
• 2 Boekholdt S M, Kramer M H. Arterial thrombosis and the role of thrombophilia.  Semin Thromb Hemost. 2007;  33 (6) 588-596
• 3 Lippi G, Franchini M. Pathogenesis of venous thromboembolism: when the cup runneth over.  Semin Thromb Hemost. 2008;  34 (8) 747-761
• 4 May R, Mignon G. [The “thrombosis of the first day of vacation”].  MMW Munch Med Wochenschr. 1981;  123 (29-30) 1173-1174
• 5 Slesak G, Döller P C. [Fever and calf tenderness after travel in Thailand: murine typhus and deep vein thrombosis].  Dtsch Med Wochenschr. 2001;  126 (22) 649-652
• 6 Allan T M, Douglas A S. Seasonal variation in deep vein thrombosis. Fatal pulmonary embolism is increased in both autumn and winter.  BMJ. 1996;  312 (7040) 1227
• 7 Boulay F, Berthier F, Schoukroun G, Raybaut C, Gendreike Y, Blaive B. Seasonal variations in hospital admission for deep vein thrombosis and pulmonary embolism: analysis of discharge data.  BMJ. 2001;  323 (7313) 601-602
• 8 Stein P D, Kayali F, Olson R E. Analysis of occurrence of venous thromboembolic disease in the four seasons.  Am J Cardiol. 2004;  93 (4) 511-513
• 9 Ho W K, Hankey G J, Eikelboom J W. The incidence of venous thromboembolism: a prospective, community-based study in Perth, Western Australia.  Med J Aust. 2008;  189 (3) 144-147
• 10 Dentali F, Manfredini R, Ageno W. Seasonal variability of venous thromboembolism.  Curr Opin Pulm Med. 2009;  15 (5) 403-407
• 11 Lippi G, Franchini M, Favaloro E J. Influenza and cardiovascular disease: does swine-origin, 2009 H1N1 flu virus represent a risk factor, an acute trigger, or both?.  Semin Thromb Hemost. 2010;  36 (1) 49-58
• 12 Kwaan H C, Bongu A. The hyperviscosity syndromes.  Semin Thromb Hemost. 1999;  25 (2) 199-208
• 13 Rampling M W. Hyperviscosity as a complication in a variety of disorders.  Semin Thromb Hemost. 2003;  29 (5) 459-465
• 14 Baskurt O K, Meiselman H J. Blood rheology and hemodynamics.  Semin Thromb Hemost. 2003;  29 (5) 435-450
• 15 Cruickshank J M, Gorlin R, Jennett B. Air travel and thrombotic episodes: the economy class syndrome.  Lancet. 1988;  2 (8609) 497-498
• 16 Hunt B J. Awareness and politics of venous thromboembolism in the United kingdom.  Arterioscler Thromb Vasc Biol. 2008;  28 (3) 398-399
• 17 Homans J. Thrombosis of the deep leg veins due to prolonged sitting.  N Engl J Med. 1954;  250 (4) 148-149
• 18 Cavanagh C. Health hazards of air travel.  Nurs N Z. 2000;  6 (11) 14-16
• 19 Philbrick J T, Shumate R, Siadaty M S, Becker D M. Air travel and venous thromboembolism: a systematic review.  J Gen Intern Med. 2007;  22 (1) 107-114
• 20 Busch F, Essen K W. Myocardial infarct during vacation.  Med Klin. 1965;  60 528-530
• 21 Marshall R J, Whatley J T. Myocardial infarction on holiday.  BMJ. 1988;  297 (6650) 738
• 22 Kloner R A, Poole W K, Perritt R L. When throughout the year is coronary death most likely to occur? A 12-year population-based analysis of more than 220 000 cases.  Circulation. 1999;  100 (15) 1630-1634
• 23 Phillips D P, Jarvinen J R, Abramson I S, Phillips R R. Cardiac mortality is higher around Christmas and New Year's than at any other time: the holidays as a risk factor for death.  Circulation. 2004;  110 (25) 3781-3788
• 24 Milne E M. Mortality spike at New Year but not Christmas in North East England.  Eur J Epidemiol. 2005;  20 (10) 849-854
• 25 Zubaid M, Thalib L, Suresh C G. Incidence of acute myocardial infarction during Islamic holiday seasons.  Eur J Epidemiol. 2006;  21 (3) 191-195
• 26 Heart of the holidays. 'Tis the season for many things–thanksgiving, celebration, fellowship, and good cheer. Oh yes, and heart attacks. We offer 12 tips for a safer, healthier holiday season.  Harv Heart Lett. 2005;  16 4-5
• 27 Näyhä S. Environmental temperature and mortality.  Int J Circumpolar Health. 2005;  64 (5) 451-458
• 28 Poole W K, Chi J S, Walton J D, Kandefer S, Kloner R A. Increased cardiovascular mortality associated with the turn of the millennium in Los Angeles County, California.  J Epidemiol Community Health. 2005;  59 (3) 205-206
• 29 Meine T J, Patel M R, DePuy V et al.. Evidence-based therapies and mortality in patients hospitalized in December with acute myocardial infarction.  Ann Intern Med. 2005;  143 (7) 481-485
• 30 Kop W J, Vingerhoets A, Kruithof G J, Gottdiener J S. Risk factors for myocardial infarction during vacation travel.  Psychosom Med. 2003;  65 (3) 396-401
• 31 Wilbert-Lampen U, Leistner D, Greven S et al.. Cardiovascular events during World Cup soccer.  N Engl J Med. 2008;  358 (5) 475-483
• 32 Haapaniemi H, Hillbom M, Juvela S. Weekend and holiday increase in the onset of ischemic stroke in young women.  Stroke. 1996;  27 (6) 1023-1027
• 33 Saposnik G, Baibergenova A, Bayer N, Hachinski V. Weekends: a dangerous time for having a stroke?.  Stroke. 2007;  38 (4) 1211-1215
• 34 Kloner R A. Can we trigger an acute coronary syndrome?.  Heart. 2006;  92 (8) 1009-1010
• 35 Lippi G, Maffulli N. Biological influence of physical exercise on hemostasis.  Semin Thromb Hemost. 2009;  35 (3) 269-276
• 36 Adams M, Williams A, Fell J. Exercise in the fight against thrombosis: friend or foe?.  Semin Thromb Hemost. 2009;  35 (3) 261-268
• 37 Kloner R A. The “Merry Christmas Coronary” and “Happy New Year Heart Attack” phenomenon.  Circulation. 2004;  110 (25) 3744-3745
• 38 Lippi G, Montagnana M, Favaloro E J, Franchini M. Mental depression and cardiovascular disease: a multifaceted, bidirectional association.  Semin Thromb Hemost. 2009;  35 (3) 325-336
• 39 Lippi G, Targher G. Cardiovascular events during World Cup soccer.  N Engl J Med. 2008;  358 (22) 2408 author reply 2409
• 40 Ettinger P O, Wu C F, De La Cruz Jr C, Weisse A B, Ahmed S S, Regan T J. Arrhythmias and the “Holiday Heart”: alcohol-associated cardiac rhythm disorders.  Am Heart J. 1978;  95 (5) 555-562
• 41 Seppä K, Sillanaukee P. Binge drinking and ambulatory blood pressure.  Hypertension. 1999;  33 (1) 79-82
• 42 Mukamal K J, Maclure M, Muller J E, Mittleman M A. Binge drinking and mortality after acute myocardial infarction.  Circulation. 2005;  112 (25) 3839-3845
• 43 Lippi G, Franchini M, Favaloro E J, Targher G. Moderate red wine consumption and cardiovascular disease risk: beyond the “French paradox”.  Semin Thromb Hemost. 2010;  36 (1) 59-70
• 44 Spira A M. Preparing the traveller.  Lancet. 2003;  361 (9366) 1368-1381