Deep Venous Thrombosis, Pulmonary Embolism and use of Warfarin

Guidance on certification of applicants with DVT, PE, Warfarin

Deep Venous Thrombosis (DVT), Pulmonary Embolism (PE) and use of Warfarin

Class 1 OML and Class 2 unrestricted certification are possible provided that, 
      1) the pilot has recovered from the underlying condition or the condition has been stabilised and does not in itself preclude flying and 
      2) the total incapacitation risk of the medication, the condition for which anticoagulation is indicated and any other conditions is acceptable.

Likely indications include:- 

• DVT/PE: Screening should have been undertaken for underlying causes, including coagulation abnormalities.  DVT is likely to be the least problematic for certification; target INR is likely to be 1.8-2.5 (with an ideal 2.0-2.3).  In all cases of pulmonary embolism follow-up reviews should be with a chest physician and reports should include relevant investigations. 
• atrial fibrillation may be associated with other risk factors, which usually means that the highest level of certification achievable will be Class 2 OSL.  (See Atrial Fibrillation flow chart)
• cardiac valve replacement.  The target INR following valve replacement and other co-morbidities should be taken into account. 
(See Aortic Valve Replacement flow chart).

Prior to certification the INR should be demonstrated to be within the target range for 6 months (4 results at 2 monthly intervals) and 2 monthly laboratory testing should be continued on an ongoing basis.  If the INR varies considerably within the target range on the initial readings, a longer period of surveillance may be required.

Class 1 applicants will be required to measure their INR on a ‘near patient’ testing system (such as CoaguChek S) 12 hours prior to flight and only fly if the INR is within the target range.  The INR should be recorded in the Log Book.  The Log Book should be reviewed at each medical certificate revalidation examination.