Medical Problem

[Dysonsphere]

Im on warfrin for a second case of DVT, spoken to local AME hes not sure about status. I am not flying right now of course , does anyone know if I can ever fly solo again.

[foxmoth]

You may be better posting this here - Medical and Health forum
Medical & Health - PPRuNe Forums (http://www.pprune.org/medical-health-62/)

CAA protocol here - Deep Venous Thrombosis, Pulmonary Embolism and use of Warfarin | Medical | Personal Licences and Training (http://www.caa.co.uk/default.aspx?catid=2499&pagetype=90&pageid=13801)

[OFSO]

Dyson, you have a PM from me. OFSO

[wondering]

Interesting target INR by the CAA - 'target INR is likely to be 1.8-2.5 (with an ideal 2.0-2.3)'. I reckon the term 'likely' makes it somewhat flexible. The FAA says one needs to be stable between 2 and 3.

When reading the last paragraph, I can´t imagine any potential employer would hire someone who is on Warfarin. IMHO that´s neither practical nor reasonable. Checking INR every day when on a seven day duty tour? And if one of the values is outside the range? Sorry, can´t fly today. For comparison, the FAA requires monthly INR values of which 80% need to be in the target range. That´s it.

Why is it so much more complicated with the CAA?

How about ppl taking Xarelto instead of Warfarin? That makes INR meaningless. I imagine that would be the way to go under those circumstances. Talk to your doctor and the CAA.

Good luck and let us know how things work out.

[Radgirl]

Dysonsphere

you are only on an anticoagulant because of an ongoing risk of a further clot or because your current clot is still there. so you cant fly at this stage and comments about different anticoagulants are irrelevant. Factor 10 antagonists are not approved for this condition in any case.

Your specialist will likely investigate why you are getting this problem. There are other treatments available but in most cases the vein 'settles down' and you are then taken off the warfarin. You will have an increased risk of further DVTs but would be expected to live a normal life and merely need to take extra precautions when undergoing operations or flying as a passenger.

So there is really no medical reason you cant fly. Of course that is a medical answer and totally unrelated to Gatwickland........

[wondering]

@Radgirl,

is your Factor 10 antagonists information by the CAA? I know the FAA approved Xarelto a year or two ago and the FDA about a year before that.

[Radgirl]

Sorry I meant approved for the management of this disease, not approved by the CAA. These drugs are approved to prevent DVTs in hip surgery, and for patients with atrial fibrillation. Other approvals will follow and some doctors are prescribing outside license. And that is in the UK, and other countries have different approvals - and some countries are so bonkers they have no rules on drugs at all it seems to some of us!!!!!

[Flyin'Dutch']

On the assumption that you have a CAA/JAR/EASA Medical

If you are a Class 1 medical holder you need to speak to the CAA AMS

for Class 2 your AME is your first port of call.

Much will depend on what the underlying cause of the recurrence is and whether the you can do the self monitoring.

Warfarin is in itself not necessary a show stopper.

[Dysonsphere]

just finally had a proper scan of the affected leg to be told all veins are XXXX and all that is keeping leg alive is the surface veins. So where bdo I go from here.:{

[Radgirl]

There are many ways to give you this information and you should not necessarily be alarmed.

After a DVT the vessels will indeed be blocked by the clot. That is the problem. It can take months for the vessels to revascularise and other veins will enlarge to take over returning blood from the limb to the heart. This is called collateral flow and is normal.

So your doctor could equally truthfully have said 'everything is as expected'!

Over months or years it may resolve but I really wouldn't worry about it. After all, if you have a coronary artery bypass the surgeon takes out the vein to use as a graft, so anyone who has had this operation is permanently in this situation! As I posted a year ago you will always have an increased risk of recurrence. You may also be interested that the new anticoagulants are gaining approvals around the world and being used more widely. Within a year we expect to have an antidote which will allow us to reverse bleeding complications, and this will probably see them replace warfarin. Hopefully the regulators will allow more pilots to fly as blood tests, INRs and 'control' will be no longer applicable.

If you are off anticoagulants I would be interested to know if you are flying again and if not why not........

[AngioJet]

When did you get your most recent DVT diagnosis? Have you been seen by a vascular specialist or a haematologist with an interest in coagulation? In a young(ish), fit patient with an extensive acute DVT (ie extending beyond the lower leg to the groin or above) we often do recommend so-called clot-busting treatment (aka thrombolysis). This often dissolves most of the residual clot and may lead to improved function in the affected leg.

However, if your DVT was diagnosed >2-4 weeks ago it may be too late for this type of treatment to work and conservative management with anticaogulation (warfarin)and compression (ie old-fashioned compression stocking) would be best advised. Usually, the thrombus does recanalise to some extent and the collateral venous flow is enhanced. However, there is a risk of developing the so-called post-thrombotic syndrome in which there is residual swelling and discomfort in the affected leg due to incomplete venous drainage through the deep veins as well as dysfunction/destruction of the valves in the veins which keep the blood from flowing back, causing venous stasis.


As has already been pointed out, you will need a workup in order to identify any triggering or predisposing factors. When was your previous DVT? For how long were you on warfarin after that? When (if at all) did you go back to flying after the first episode?