Anticoagulation, Warfarin

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Overt incapacitation
- Distracting pain from gastrointestinal haemorrhage or cerebrovascular bleed
- Loss of consciousness from cerebrovascular bleed
- Sudden death

When commencing warfarin, a minimum of three INRs are required at least one week apart and must be within the target range.

A report from the treating doctor will be required.

When commencing warfarin, a minimum of three INRs are required at least one week apart and must be within the target range
Monitoring regime including compliance with and stability of antiplatelet and anticoagulant medication
Subsequent serial INR results performed at least monthly or more frequently if operationally appropriate
Any side-effects should be notified to CASA
Estimate of annualised percentage risk of incapacitation
Follow-up plan

Warfarin and Novel Oral Anticoagulants (NOACs) are approved by CASA AVMED for use by pilots and controllers whilst exercising the privileges of their medical certificate. However, Class 1 and Class 3 medical certificate holders using anticoagulation medication will be subject to multi-crew/proximity restrictions (see separate guideline on NOACs)
Pilots and controllers on Warfarin are to be grounded if their INR is outside the range 1.5 to 4.0. OR if persistently outside designated target range for anticoagulant treatment
Pilots and Controllers prescribed Clexane will not be cleared to exercise the privileges of their certificate. (Clexane may be used in combination with Warfarin during the initial treatment while grounded)
Initial notification to CASA and grounding is required on diagnosis of the underlying condition and commencement of Warfarin anticoagulation
Clearance by CASA is required before exercising privileges
Permanent multi-crew restriction will be likely if anticoagulation is required long term
Cumulative risk assessment performed by CASA includes:
- risks associated with the medication
- risks due to the condition for which anticoagulation is indicated
- additive risks due to other co-morbid conditions

Stabilised therapeutic warfarin treatment (within target INR range)
NOACs e.g. Rivaroxaban, Dabigatran and Apixaban (see separate guideline on NOACs)

Clexane (acceptable during initial combination treatment with Warfarin but unacceptable for long term treatment)

Anticoagulation is an aero-medically significant treatment.
The conditions which require warfarin treatment are serious. Poor control of warfarin can cause a large increase in health risks. This is why it matters that it is very carefully managed.
Pilots and controllers who are commenced on anticoagulation are required to ground themselves and notify this treatment to their DAME and CASA.
Permanent multi-crew restriction will be likely if anticoagulation is required long term
Pilots or controllers considering point of care INR testing are strongly advised to discuss this with CASA Aviation Medicine

The Clinical Practice Guideline is provided by way of guidance only and subject to the Clinical practice guidelines disclaimer