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1 Medical Research Institute of New Zealand, 2 Wellington Hospital, Capital & Coast District Health Board, Wellington, New Zealand and 3 University of Southampton, Southampton, UK
CORRESPONDENCE: R. Beasley, Medical Research Institute of New Zealand, PO Box, 10055, Wellington, New Zealand. Fax: 64 44729224. E-mail: richard.beasley@mrinz.ac.nz
Keywords: deep vein thrombosis, eThrombosis, immobility, pulmonary embolism, venous thromboembolism
Received: May 13, 2002
Accepted June 26, 2002
Abstract
The association between immobility with prolonged sitting and venous thromboembolism has been recognised for >60 yrs, most recently with long distance air travel. The case of a 32-yr-old male, in whom immobility associated with sitting for long periods at a computer represented the major provoking risk factor for his life-threatening venous thromboembolism, is presented. The authors propose the term "eThrombosis" to describe this 21st Century variant of venous thromboembolism associated with immobility from prolonged sitting. In view of the widespread use of computers in relation to work, recreation and personal communication, the potential burden of eThrombosis may be considerable.
Case report
The authors report the case of a 32-yr-old male who gave a history of a swollen painful calf 6 weeks previously, which resolved after 10 days. During the 4 weeks prior to presentation he noticed increasing breathlessness on exertion, to the extent that he was breathless during minimal activity. On the day of the presentation he experienced a syncopal episode in which he lost consciousness. He denied haemoptysis or pleuritic pain; there was no family history of VTE. On examination he was afebrile, heart rate 120 beats·min–1, blood pressure 130 over 95, respiratory rate 20 breaths·min–1, jugular venous pressure not raised, chest clear on auscultation and prominent facial contusions were noted.
The electrocardiogram showed sinus tachycardia and severe right heart strain (fig. 1
); arterial blood gases on room air showed pH 7.45, carbon dioxide arterial tension 3.86 kPa (29 mmHg), arterial oxygen tension 7.45 kPa (56 mmHg), bicarbonate 19 mmol·L–1, oxygen saturation 93% and the chest radiograph showed prominence of the hila and airspace consolidation of the superior segment of the left lower lobe. A provisional diagnosis of pulmonary embolism was made and this was confirmed by pulmonary angiography with helical computer tomography angiogram, which showed extensive bilateral proximal thrombus (figs. 2 and 3). Echocardiography showed paradoxical interventricular septal movement, a dilated right ventricle, a right ventricular pressure of 25 mmHg and no evidence of intracardiac thrombus. A decision was made not to administer thrombolysis, due to the risk of intracerebral bleeding associated with his traumatic head injury. Instead, he received short-term low molecular weight heparin and concomitant oral warfarin, which was continued for a 6-month period. Following this 6-month period he reported that he had made a full symptomatic recovery. A follow-up ventilation/perfusion scan indicated that there had been a marked resolution of the pulmonary emboli and a thrombophilia screen was normal. A Doppler ultrasound examination of the lower limbs was not undertaken on the basis that it would not influence management.
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Discussion
To the authors' knowledge, this is the first reported case of an association between repeated prolonged immobility sitting at a computer and life-threatening VTE. The term "eThrombosis" to describe this 21st Century variant of thrombosis associated with immobility from prolonged sitting is proposed.
The incidence of this condition may be substantial when considering the widespread use of computers in so many aspects of modern life. For example, in the USA, one-half of all employed adults use a computer at work, just over one-half of all households have a computer and home internet use doubled in the 3 yrs from 1997–2000 5, 6. This trend represents a major increase in exposure to a possible risk factor for VTE.
It will be necessary to obtain some estimate of the degree of risk associated with immobility while sitting using a computer, to enable appropriate recommendations to be made regarding prophylaxis. With the current state of knowledge it would seem prudent to advise all individuals who commonly sit for prolonged periods at a computer to undertake frequent leg and foot exercises and take regular breaks for mobilisation away from the computer. In this way it may be possible to reduce the potential considerable burden of "eThrombosis".
Acknowledgements
The authors wish to thank D. Fabian for assistance in preparing the manuscript and W. Beasley, who proposed the term "eThrombosis".
References
This article has been cited by other articles:
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  J. West, K. Perrin, S. Aldington, M. Weatherall, and R. Beasley A case-control study of seated immobility at work as a risk factor for venous thromboembolism J R Soc Med, May 1, 2008; 101(5): 237 - 243. [Abstract] [Full Text] [PDF]
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 V. F. Tapson Acute Pulmonary Embolism N. Engl. J. Med., March 6, 2008; 358(10): 1037 - 1052. [Full Text] [PDF]
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 P. S. Gerard, P. Gerczuk, and M. Mattern "eThrombosis": Are Radiologists at Risk? Am. J. Roentgenol., May 1, 2007; 188(5): W491 - W491. [Full Text] [PDF]
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 F. R. Rosendaal Venous Thrombosis: The Role of Genes, Environment, and Behavior Hematology, January 1, 2005; 2005(1): 1 - 12. [Abstract] [Full Text] [PDF]
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