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Anticoagulation fact sheet

Anticoagulants

Anticoagulants are a type of anti-clotting medicine used to prevent harmful blood clots in the body. They play an important role in health because blood clots can cause serious conditions like deep vein thrombosis (a blood clot in the veins of the legs), pulmonary embolism (a blood clot in the lungs), or a stroke (a blood clot in a blood vessel in the brain).

Sometimes incorrectly called ‘blood thinners,’ anticoagulants like warfarin actually work by reducing blood clotting. Anticoagulants used to prevent stroke and blood clots include:

  • Warfarin (coumadin and marevan)
  • Dabigatran (pradaxa)
  • Apixaban (eliquis)
  • Rivaroxaban (xarelto)

warfarin

warfarin is used by thousands of people to prevent blood clots.

  • If you take warfarin, it is important that you know how to use it safely and correctly, to avoid side effects, especially bleeding.
  • To help make sure that warfarin is working safely and effectively in your body, you will need regular blood tests (monitoring).

Dabigatran (pradaxa)

Dabigatran (pradaxa) is an anticoagulant, used to help prevent problems caused by harmful blood clots, such as stroke. Anticoagulants are a type of anti-clotting medicine. Dabigatran is a relatively new medicine taken in a capsule. It can be used by:

  • people with atrial fibrillation as an ongoing treatment to prevent stroke, as an alternative to warfarin
  • people who have had hip or knee replacement surgery, in order to prevent harmful blood clots. Enoxaparin (clexane) or dalteparin (fragmin) injections (low molecular weight heparins) are the more commonly used alternatives.

Pradaxa is available in capsules. As with other anti-clotting medicines (anticoagulant and antiplatelet medicines), there is a risk of bleeding as a side effect with dabigatran.

Apixaban (Eliquis)

Apixaban (Eliquis) is another new medicine. It is used to prevent blood clots in veins after a hip or knee replacement surgery.

  • It is also used to prevent stroke and blood clots in a condition called atrial fibrillation, which is a type of abnormal heart rhythm.
  • With atrial fibrillation, part of the heart does not beat the way it should. This can lead to blood clots forming and increase your risk of having a stroke.
  • It works by inhibiting a blood clot forming substance called Factor Xa. As with other anti-clotting medicines (anticoagulant and antiplatelet medicines), there is a risk of bleeding-related side effects if you are taking apixaban.

Rivaroxaban (xarelto)

Rivaroxaban (xarelto) is a relatively new anticoagulant medicine used to help prevent problems caused by harmful blood clots. Rivaroxaban can be used to:

  • prevent blood clots in people who’ve had hip or knee replacement surgery
  • prevent stroke in people with atrial fibrillation who have at least one other risk factor for stroke, such as diabetes or hypertension
  • treat and prevent deep vein thrombosis (DVT)
  • treat and prevent pulmonary embolism (PE).

As with other anti-clotting medicines (anticoagulant and antiplatelet medicines), there is a risk of bleeding-related side effects if you are taking rivaroxaban.

Effect of aviation on treatment

  • The effectiveness of some anticoagulants depends on a stable diet. Variable dietary control during flight can cause problems.

Effect of treatment on aviation

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

Approach to medical certification

  • Anticoagulation is an aero-medically significant treatment.
  • Medical conditions requiring warfarin treatment are serious. Poor control of warfarin can cause a large increase in health risks. This is why it must be 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.
  • When commencing warfarin, a minimum of three INRs are required at least one week apart and must be within the therapeutic range.

More likely to be certified

You are more likely to be certified or recertified if you are taking:

  • therapeutic warfarin treatment  and your condition is stabilized within specified INR range
  • aspirin

Less likely to be certified

You are less likely to be certified or recertified if you are taking:

  • Clexane (acceptable during initial combination treatment with warfarin but unacceptable for long term treatment)
  • New anticoagulants eg rivaroxaban, dabigatran, ximelagatran, and apixaban

You are unique

Every patient taking anticoagulants is different. CASA makes aeromedical decisions on a case by case basis. A particular assessment decision is based on the individual circumstances of the applicant under consideration.

Further information

For further information see: