Deep Vein Thrombosis

Feedback

If you find any errors or omissions in these Guidelines, or feel that something in them needs to change, write to:

Please include details of the page on which you wish to provide feedback.

Thank you for your assistance in ensuring that these Guidelines are up to date and correct.

confirmed diagnosis of deep vein thrombosis
exclusion of other diagnoses
- clinically evident pulmonary embolus
- predisposing disease pro-thrombotic malignancy, pro-thrombotic haematological disease
Acceptable prognosis - risk of recurrence, risk of incapacitation

Acceptable, stable treatment without significant side effects
Demonstration of adherence
1. If commencing warfarin, a minimum of three INRs are required at least one week apart and must be within the therapeutic range (see guidelines for Anticoagulation – Warfarin)
2. If commencing NOAC then confirmation of adherence to medication (see guideline for Anticoagulation - NOACs)

Absence of symptoms eg distracting calf pain, chest pain and shortness of breath
Interval ultrasound evidence of thrombus stabilisation

Confirmed diagnosis
- Provoked or Unprovoked DVT
- Exclusion of PE (see guidelines on Pulmonary Embolus)
- Pre-disposing co-morbidities
Clinical status
- history of condition
- details of any symptoms
Investigations conducted
- procoagulant screen (conducted before or after anticoagulant treatment)
- ultrasound or CT scans
Management
- treatment: response to treatment and side effects
- monitoring regimen including adherence with and stability of
- anticoagulant medication
- (ie, serial INR results (or proof of NOAC adherence)
- any side-effects
Underlying cause of thrombosis
Estimate of annualised percentage risk of recurrence
Estimate of annualised percentage risk of incapacitation
Follow-up plan

Clinical status
- history of condition
- details of any symptoms
Investigations conducted
- pro-coagulant screen (if not done prior)
- ultrasound or CT scans
Management
- treatment: response to treatment and side effects
- monitoring regimen including adherence with and stability of
- anticoagulant medication
- (ie, serial INR results (or proof of NOAC adherence)
- regimenany side-effects
Underlying cause of thrombosis
Estimate of annualised percentage risk of recurrence
Estimate of annualised percentage risk of incapacitation
Follow-up plan

DAME comments. (Additional reports may be needed for long-term treatment.)

Initial notification to CASA and grounding required pending diagnosis
Clearance by CASA required before exercising privileges
Interval assessment at 6 months
Audit will be required with review at 12 months
Both due to the risk of recurrent DVT/PE and anticoagulation treatment, certificates may be subject to long term multi-crew/proximity restriction (Class 1 and 3)
See guidelines for Anticoagulation – Warfarin and Anticoagulation - NOACs

DVT is an aero-medically significant medical condition because blood clots can move and affect the lungs heart or brain
Pilots and controllers who have been diagnosed with DVT are required to ground themselves and notify this condition to their DAME or CASA.
Anticoagulant medication is associated with well recognised hazards (ie. bleeding) which must be considered as a separate risk to aviation safety
Effective and stable treatment is critical in reducing these risks
If cleared to exercise the privileges of a medical certificate, long term multi-crew/proximity restriction and audit may be required (Class 1 and 3)

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