The thrombotic risk of spaceflight: has a serious problem been overlooked for more than half of a century?

The first ever venous thrombotic condition associated with spaceflight, an internal jugular vein thrombus requiring anticoagulation, has recently been reported. Systematic investigation of space travel-associated thrombotic risk has not been conducted. Cellular, animal, and human studies performed in ground-based models and in actual weightlessness revealed influences of weightlessness and gravity on the blood coagulation system. However, human study populations were small and limited to highly selected participants. Evidence in individuals with medical conditions and older persons is lacking. Evidence for thrombotic risk in spaceflight is unsatisfactory. This issue deserves further study in heterogeneous, high risk populations to find prevention strategies and to enable safe governmental and touristic human spaceflight.

[1]  James M. Pattarini,et al.  Venous Thrombosis during Spaceflight. , 2020, The New England journal of medicine.

[2]  P. Norsk.  Adaptation of the cardiovascular system to weightlessness: Surprises, paradoxes and implications for deep space missions , 2019, Acta physiologica.

[3]  Stuart M. C. Lee,et al.  Assessment of Jugular Venous Blood Flow Stasis and Thrombosis During Spaceflight , 2019, JAMA network open.

[4]  Yinghui Li,et al.  Multi-System Adaptation to Confinement During the 180-Day Controlled Ecological Life Support System (CELSS) Experiment , 2019, Front. Physiol..

[5]  Satish K. Mehta,et al.  Herpes Virus Reactivation in Astronauts During Spaceflight and Its Application on Earth , 2019, Front. Microbiol..

[6]  P. Cerretelli,et al.  Recovery from 6-month spaceflight at the International Space Station: muscle-related stress into a proinflammatory setting , 2019, FASEB journal : official publication of the Federation of American Societies for Experimental Biology.

[7]  E. Gaetani,et al.  Differences in Clinical Presentation, Rate of Pulmonary Embolism, and Risk Factors Among Patients With Deep Vein Thrombosis in Unusual Sites , 2019, Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis.

[8]  Paolo Prandoni,et al.  Diagnosis and management of acute deep vein thrombosis: a joint consensus document from the European Society of Cardiology working groups of aorta and peripheral vascular diseases and pulmonary circulation and right ventricular function. , 2018, European heart journal.

[9]  C. Suschek,et al.  Blue light exposure decreases systolic blood pressure, arterial stiffness, and improves endothelial function in humans , 2018, European journal of preventive cardiology.

[10]  F. Mannello,et al.  Chronic Venous Disorders: The Dangerous, the Good, and the Diverse , 2018, International journal of molecular sciences.

[11]  Scott M Smith,et al.  Increased core body temperature in astronauts during long-duration space missions , 2017, Scientific Reports.

[12]  R. Simpson,et al.  Alterations in hematologic indices during long-duration spaceflight , 2017, BMC Hematology.

[13]  C. Borchers,et al.  Protein expression changes caused by spaceflight as measured for 18 Russian cosmonauts , 2017, Scientific Reports.

[14]  Stuart M. C. Lee,et al.  Internal jugular pressure increases during parabolic flight , 2016, Physiological reports.

[15]  Varsha Jain,et al.  Medically induced amenorrhea in female astronauts , 2016, npj Microgravity.

[16]  N. Goswami,et al.  Effects of Exercise and Nutrition on the Coagulation System During Bedrest Immobilization , 2015, Medicine.

[17]  K. Zuj,et al.  Measurements of jugular, portal, femoral, and calf vein cross-sectional area for the assessment of venous blood redistribution with long duration spaceflight (Vessel Imaging Experiment) , 2015, European Journal of Applied Physiology.

[18]  N. Goswami,et al.  Bed rest does not induce hypercoagulability , 2015, European journal of clinical investigation.

[19]  W. Kremers,et al.  Experimental Sleep Restriction Causes Endothelial Dysfunction in Healthy Humans , 2014, Journal of the American Heart Association.

[20]  S. le Cessie,et al.  No effect of isolated long‐term supine immobilization or profound prolonged hypoxia on blood coagulation , 2014, Journal of thrombosis and haemostasis : JTH.

[21]  J. Rittweger,et al.  Petechiae: reproducible pattern of distribution and increased appearance after bed rest. , 2013, Aviation, space, and environmental medicine.

[22]  A. Larsson,et al.  Downregulation of platelet activation markers during long-term immobilization , 2013, Platelets.

[23]  N. Goswami,et al.  Coagulation Changes during Presyncope and Recovery , 2012, PloS one.

[24]  Khader M Hasan,et al.  Orbital and intracranial effects of microgravity: findings at 3-T MR imaging. , 2012, Radiology.

[25]  Martina Heer,et al.  Vision changes after spaceflight are related to alterations in folate- and vitamin B-12-dependent one-carbon metabolism. , 2012, The Journal of nutrition.

[26]  Simon J Mitchell,et al.  Decompression illness , 2011, The Lancet.

[27]  F. Rosendaal,et al.  Venous thrombosis in the elderly: incidence, risk factors and risk groups , 2010, Journal of thrombosis and haemostasis : JTH.

[28]  M. Custaud,et al.  Enforced physical inactivity increases endothelial microparticle levels in healthy volunteers. , 2010, American journal of physiology. Heart and circulatory physiology.

[29]  Guanglei Liu,et al.  Mechanism of platelet functional changes and effects of anti-platelet agents on in vivo hemostasis under different gravity conditions. , 2010, Journal of applied physiology.

[30]  F. Boehlen,et al.  Fibrinogen and the Risk of Thrombosis , 2010, Seminars in thrombosis and hemostasis.

[31]  P. Malone,et al.  Is ‘Virchow’s triad’ useful? , 2009, British journal of haematology.

[32]  Q. Shi,et al.  Hypergravity results in human platelet hyperactivity , 2009, Journal of Physiology and Biochemistry.

[33]  Rupert Gerzer,et al.  Hypergravity and microgravity influence haemostasis , 2009, Thrombosis and Haemostasis.

[34]  Rong Yan,et al.  Effects of microgravity and hypergravity on platelet functions , 2009, Thrombosis and Haemostasis.

[35]  F. Rosendaal,et al.  Current perspective of venous thrombosis in the upper extremity , 2008, Journal of thrombosis and haemostasis : JTH.

[36]  G. Jacob,et al.  Orthostatic Hypercoagulability: A Novel Physiological Mechanism to Activate the Coagulation System , 2008, Hypertension.

[37]  I. Préda,et al.  Generalized alterations in the biomechanical properties of large veins in non-thrombotic thrombophilic young patients. , 2008, International angiology : a journal of the International Union of Angiology.

[38]  H. Büller,et al.  Travel and venous thrombosis: a systematic review , 2007, Journal of internal medicine.

[39]  Christine E. Hellweg,et al.  Getting ready for the manned mission to Mars: the astronauts’ risk from space radiation , 2007, Naturwissenschaften.

[40]  T. Stein,et al.  Plasma protein synthesis after spaceflight. , 2006, Aviation, space, and environmental medicine.

[41]  Scott M Smith,et al.  The nutritional status of astronauts is altered after long-term space flight aboard the International Space Station. , 2005, The Journal of nutrition.

[42]  F. Bernardi,et al.  Daily and Circadian Rhythms of Tissue Factor Pathway Inhibitor and Factor VII Activity , 2005, Arteriosclerosis, thrombosis, and vascular biology.

[43]  B. Dickson.  Virchow's triad? , 2004, Southern medical journal.

[44]  D. Watenpaugh,et al.  Fluid volume control during short-term space flight and implications for human performance. , 2001, The Journal of experimental biology.

[45]  W M O'Fallon,et al.  Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study. , 1998, Archives of internal medicine.

[46]  W. Rowe.  The Apollo 15 space syndrome. , 1998, Circulation.

[47]  T P Stein,et al.  Diet and nitrogen metabolism during spaceflight on the shuttle. , 1996, Journal of applied physiology.

[48]  C. G. Blomqvist,et al.  Central venous pressure in space. , 1996, The New England journal of medicine.

[49]  P. Reitsma,et al.  Hyperhomocysteinemia as a risk factor for deep-vein thrombosis. , 1996, The New England journal of medicine.

[50]  T P Stein,et al.  Excretion of IL-6 by astronauts during spaceflight. , 1994, The American journal of physiology.

[51]  C. G. Blomqvist,et al.  Central venous pressure in space. , 1993, Journal of applied physiology.

[52]  W. Hollmann,et al.  Effects of simulated microgravity (HDT) on blood fluidity. , 1992, Journal of applied physiology.

[53]  L. Dintenfass.  Effect of zero gravity on blood cells and viscosity , 1990, The Lancet.

[54]  W. Gasper,et al.  Vein graft failure. , 2015, Journal of vascular surgery.

[55]  R. von Känel.  Acute mental stress and hemostasis: When physiology becomes vascular harm. , 2015, Thrombosis research.

[56]  L. Ploutz-Snyder,et al.  Risk of Hypoxia from the Exploration Atmosphere 1 Evidence Report : Risk of Hypobaric Hypoxia from the Exploration Atmosphere , 2015 .

[57]  T. C. Wiener,et al.  Space obstructive syndrome: intracranial hypertension, intraocular pressure, and papilledema in space. , 2012, Aviation, space, and environmental medicine.

[58]  R. Busse,et al.  Endothelial aging. , 2005, Cardiovascular research.