Journal of Medical Academics

Register      Login

VOLUME 2 , ISSUE 1 ( January-June, 2019 ) > List of Articles

Original Article

Spectrum of Thrombotic Disorders in Soldiers Serving in High-altitude Areas

Muthukrishnan Jayaraman, Ashwin Mahesh, Sourya S Mohakuda

Keywords : Altitude, Soldiers, Thrombosis

Citation Information : Jayaraman M, Mahesh A, Mohakuda SS. Spectrum of Thrombotic Disorders in Soldiers Serving in High-altitude Areas. Journal of Medical Academics 2019; 2 (1):17-19.

DOI: 10.5005/jp-journals-10070-0027

License: CC BY-NC 4.0

Published Online: 01-08-2019

Copyright Statement:  Copyright © 2019; The Author(s).


Abstract

Background: Indian soldiers serve in extreme climatic conditions at uninhabitable altitudes. Only few studies and case reports have described various thrombotic disorders in soldiers serving in high altitude (HA). It is postulated that there is activation of intravascular coagulation cascade and factors such as low temperatures, dehydration, polycythemia, stress, and hypoxia have been implicated. Aim: To study the spectrum of thrombotic disorders occurring in soldiers serving in high-altitude areas (>10,000 feet). Setting: The study was conducted at a tertiary-level referral centre for troops deployed in HA regions. The study involved a retrospective analysis of records of patients presenting with thrombotic disorders while being posted to HA. The duration of the study was between February 2012 and March 2014. Materials and methods: Diagnosis, patient particulars, all investigations (including the thrombophilia workup), and treatment given were recorded. Patients with any pre-existing diseases were excluded from the study. Descriptive statistics were used for data analysis. Results: Totally, 69 male patients were presented with thrombotic disorders during the study period. Only 30 (43.4%) patients had pulmonary embolism, 18 (26%) cerebral venous thrombosis, 9 (13%) acute coronary syndrome, 7 (10.1%) deep vein thrombosis, 4 (5.7%) arterial stroke, and 1 (1.4%) had retinal vein thrombosis. An estimated 14 (20.2%) were smokers and 3 (4.3%) patients were highlanders. The procoagulant workup was positive in 10 (14.4%) patients, and 34 (49.2%) patients had polycythemia. The mean duration of stay at HA was 5 ± 2 months. There was no mortality. Conclusion: Only 14.4% of patients showed prothrombotic states. The role of causative factors and the unknown prothrombotic condition in HA needs further investigation by trials involving a larger study population.


HTML PDF Share
  1. Acosta MP. High altitude warfare: The Kargil conflict and the future. Masters of Arts Thesis, Naval Post Graduate School, Monterey, California, June 2003.
  2. Dutta V, Singh R, et al. Profile of pulmonary embolism in service personnel posted at high altitude area. Indian Heart J 2018 May–Jun;70(3):427–429. DOI: 10.1016/j.ihj.2017.08.002.
  3. Anand AC, Saha A, et al. Symptomatic portal system thrombosis in soldiers due to extended stay at extreme high altitude. J Gastroenterol Hepatol 2005;20:777–783. DOI: 10.1111/j.1440-1746.2005.03723.x.
  4. Khalil KF, Saeed W. Pulmonary embolism in soldiers serving at high altitude. J Coll Physicians Surg Pak 2010 Jul;20(7):468–471. DOI: 07.2010/JCPSP.468471.
  5. Martinelli I, Bucciarelli P, et al. Thrombotic risk factors: basic pathophysiology. Crit Care Med 2010;38:S3–S9. DOI: 10.1097/CCM.0b013e3181c9cbd9.
  6. West JB. The physiological basis of high-altitude diseases. Ann Intern Med 2004;141:789–800. DOI: 10.7326/0003-4819-141-10-200411160-00010.
  7. Turan O, Ündar B, et al. Investigation of inherited thrombophilias in patients with pulmonary embolism. Blood Coagul Fibrinolysis 2013;24(2):140–149. DOI: 10.1097/MBC.0b013e328359db0e.
  8. Wirtz HP, Bärtschi C, et al. Effect of oral melatonin on the procoagulant response to acute psychosocial stress in healthy men: a randomized placebo controlled study. J Pineal Res 2008;44(4):358–365. DOI: 10.1111/j.1600-079X.2007.00535.x.
  9. Gupta R, Joshi P, et al. Epidemiology and causation of coronary heart disease and stroke in India. Heart 2008;94:16–26. DOI: 10.1136/hrt.2007.132951.
  10. Bärtsch P. How thrombogenic is hypoxia? JAMA 2006;295:2297–2299. DOI: 10.1001/jama.295.19.2297.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.