Hairdressers are among the risk groups for suffering thrombosis or pulmonary embolism. What risk factors are there, and what can be done? An article by Jens Dagné.
Sitting or standing – which is more dangerous for thrombosis?
This question from Jens Dagné was answered by Dr med. Christian Moerchel — appropriately timed for World Thrombosis Day on 13 October. This is the birthday of Rudolf Virchow, who contributed significantly to the understanding of thrombosis in Berlin over 100 years ago. The date has been observed as World Thrombosis Day since 2014.
Deep vein thrombosis or pulmonary embolism is therefore not a typical sign of old age, but a preventable condition.
What is thrombosis?
Deep vein thrombosis or pulmonary embolism is the result of the chance coincidence of several risk factors, such as lack of movement, a change in blood coagulation, and surgery or other internal medical conditions. Many further factors such as obesity, the use of hormones or cytostatic drugs, pregnancies or inflammatory bowel diseases can influence an individual’s risk of deep vein thrombosis or pulmonary embolism.
Treatment
The most effective treatment for the condition is anticoagulation (the administration of a medication to inhibit blood clotting). Many doctors and patients have their difficulties with this, however. Classic anticoagulation with vitamin K antagonists requires close monitoring with regular blood draws, varying daily doses and restrictions on certain foods. This is different with newly developed direct oral anticoagulants. These do not inhibit the synthesis of coagulation factors in the liver and do not require regular coagulation monitoring.
When these medications came onto the market in Germany in 2011, there was great hesitancy. They were more expensive than the previous vitamin K antagonists, and anticoagulation without regular coagulation monitoring was seen as dangerous. This has since changed. German doctors have been prescribing the new medications more and more since 2012, with rivaroxaban (Xarelto®) being the most frequently prescribed according to the lists of prescribed medicines published by statutory health insurers.
Sitting or standing – which is more dangerous for thrombosis?
This question was often put to well-known hairdresser Jens Dagné from Worms, and he has therefore been preoccupied for many years with the effects of prolonged standing in his profession. There are studies on the potential link between physical occupational strain and long-term sick leave. A Danish study involving 11,908 wage earners covering the years 2000 to 2005 showed that spending 25 per cent or more of total working time in a bent or twisted posture increases the risk of long-term sick leave (at least three consecutive weeks) by a factor of 1.6. Squatting or kneeling increases the risk by a factor of 1.3. Even when differences in age, sex, psychosocial working environment, lifestyle, musculoskeletal and mental disorders were taken into account, this association persisted (Andersen 2016).
Another Danish study showed that working people who potentially sit for longer periods in ergonomically unfavourable positions have a significantly higher risk of pulmonary embolism compared with people with dynamic physical activity (Suadicani 2012).
As early as 2005, a New Zealand working group had coined the term SIT (seated immobility thromboembolism) for venous thromboembolism associated with sitting, describing it as a new lifestyle-associated disease of the 21st century (Beasley 2005).
Occupational standing strain, as is typical in hairdressing, is not associated with an increased risk of thromboembolic events according to the literature, but it is associated with the worsening of varicose veins. This is a common condition in the general population that increases with age. An Iranian study, however, showed that prolonged standing more than doubles hairdressers’ risk of varicose veins (Ebrahimi 2015). A British study found that for hairdressers aged 45 or under, a family history of varicose veins is the most important risk factor for the condition. For hairdressers over 45, however, the effects of occupational strain are the primary concern.
Hairdressers over the age of 45 who stand for more than 260 hours per month have a 32-fold increased risk of varicose veins. Hairdressers who have worked standing for more than 30 years have an 11-fold increased risk. Jens Dagné recommends above all to his employees that, wherever possible, they work seated on a rolling stool, so that the work alternates between standing and sitting. This means that muscle movement helps counteract thrombosis. In addition, in cases of acute risk, the wearing of compression support stockings is of course recommended.
Unfortunately, there is still no effective therapy to prevent varicose veins.
Source: Dr phil. Michael Moerchel
Photo: Christoph Burgstedt@adobe.stock
