Pulmonary Embolus

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.

Overt incapacitation
- Distracting pain
- Acute shortness of breath
- Sudden death
Subtle incapacitation
- Impaired lung function

Confirmed diagnosis of pulmonary embolus
Absence of significant sequelae
Presence of other diagnoses eg pro-thrombotic malignancy, 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 chest pain and shortness of breath
Interval ultrasound evidence of deep vein thrombus stabilisation (if applicable)

Confirmed diagnosis
- Provoked or unprovoked Pulmonary Embolus
- Isolated Pulmonary Embolus or Pulmonary Embolus with DVT
- Pre-disposing co-morbidities
Clinical status
- history of condition
- details of any symptoms
- Absence of significant sequelae (e.g. assessment for right ventricular dysfunction)
Investigations conducted
- pro-coagulant 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
- pre-disposing co-morbidities
- details of any symptoms
Investigations conducted
- pro-coagulant screen (if not done prior)
- ultrasound or CT scans
- assessment for right ventricular dysfunction
Management
- treatment: response to treatment and side effects
- monitoring regimen including adherence with and stability of anticoagulant medication
- (ie, serial INR results (performed at least monthly and must be within the target range)
- any 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.)

PE may indicate a poor prognosis in the short and long term
CASA will conduct a risk assessment based on history of PE and co-morbidities
Initial notification to CASA and grounding required on 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

PE is an aero-medically significant medical condition because it affects lung and heart function. A new PE can cause significant pain.
Pilots and controllers who have been diagnosed with PE 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