Flying after DVT and PE

[Martin5345]

Hello,

Anyone here with some professional aeromedical knowledge?

As an EASA ATPL holder I'm already flying around a few years with some 5 digit number of hours, but recently something happened that was new to me. I experienced a double PE (Pulmonary Embolism) in my free days, and I survived. Totally unexpected. Caused by a DVT (Deep Vane Trombosis), was the diagnosis, and after further examinations in hospital they discovered I had Factor V Leiden (confirmed) and APS (Antiphospholipid Syndrome)(to be confirmed again) in my blood.

I am now under anticoagulant treatment, and I understand that that will be for life, because of the aggravating complications. Of course my medical Class I has been suspended. I am already anticipating a definitive suspension, but I was wondering if there are any medical developments that could cure me of the effects of the complications, or make the anticoagulant treatment easier or unnecessary, or even fly while a stable treatment gives good INR values?

Thanks!

[AngioJet]

Sorry to hear about your illness. Depending on where you hold your license, it may be possible to get recertified for class 1 after 6mnths of stable INR values within the target range. The class 1 would probably be issued with an OML restriction. If you're in the UK, see the following document for guidance. Cardiovascular System - General | Medical | Personal Licences and Training (http://www.caa.co.uk/default.aspx?catid=2499&pagetype=90&pageid=13796#ThromboEmb)

[Martin5345]

Thanks AngioJet

Yes I know these documents. But would that work even though I need continuous treatment because of the complications I have?

[Alsacienne]

Ah this is a tough one which may may mean you need to remove clots in your legs.
Are you taking doses of vitamin K?

If you have had any clots, I am sure they will already 'dissolved' or moved to a safe area by medication when you were being treated for your PEs.

If you have the issues that the OP described and are on anti-coagulants, you have to control your amount of vitamin K .... usually done by what you eat. Taking doses of vitamin K sounds both dangerous and unlikely.

The OP needs to listen to his medical advisors on how to handle what will be a life-long condition and not us 'enthusiasts' even if we've been in a similar situation as regards his MEDICAL treatment.

Of course, for aviation aspects, this forum can be very helpful but we should not advise on medical treatment (unless of course we are trained medical doctors as distinct from Ph.D or D.Phil or D.Aeronautics).

[Martin5345]

Thanks Winnerhofer!

Yes the anticoagulant treatment with Sintrom is making my blood thinner and removing the clots. Are there any medicines or anything else, like vitamin K, rivaroxaban or NOACs, available now or in the future, that would make the anticoagulant treatment unnecessary?

My double PE was quickly cured by Heparin and a lot of oxygen, and a lot of rest, so after a few weeks the heart muscles didn't suffer so much and my physical condition is fortunately as before I had the PE's.

Remains the question if I ever will be able to get my Class I medical again.

Thanks for your help and your best wishes!

[Martin5345]

Hello Alsacienne,

No I am of course taking exactly what my doctors are prescribing me, which is Sintrom under medical control of my INR values. No Vitamin K or anything else.

But I was wondering, also a lot of colleagues and friends are asking me, if there are any serious medical alternatives which makes the anticoagulant treatment easier or shorter, which would enable me to re-apply for a Class 1 ever.

Thanks

[AngioJet]

Basically, you will need continued evaluation by either a coagulation specialist, a respiratory physician or both. The 'treatment' phase of anticoagulation is only the immediate period following your diagnosis, when symptoms improve you move on to the 'prophylactic' phase to prevent repeat occurrences. In your case, with both FV Leiden and APS it seems as though this would be lifelong. The above CAA document refers to prophylactic anticoagulation which is what your treatment will be classed as in the longer term.

You will need to discuss your treatment options with your AME or with the CAA. Unfortunately, there are no medications that will reduce the side effects of ongoing anticoagulant treatment (i.e. bleeding and bruising) except for careful INR-monitoring to ensure that you are within the therapeutic range.

Good luck!

[Martin5345]

@Alsacienne
I am very interested in reading similar experiences and useful information from professional pilots, colleagues, and people with aeromedical knowledge, just to have some more background information

@AngioJet
Yes they've already confirmed it will be a lifelong treatment. Due to the aggravating complications my AME is not very positive about a new issue of Class 1 licence

Thank you all for your help!;)

[gingernut]

Hi Martin, I think you need to seek some medical advice.

This seems like good advice though...

Basically, you will need continued evaluation by either a coagulation specialist, a respiratory physician or both. The 'treatment' phase of anticoagulation is only the immediate period following your diagnosis, when symptoms improve you move on to the 'prophylactic' phase to prevent repeat occurrences. In your case, with both FV Leiden and APS it seems as though this would be lifelong. The above CAA document refers to prophylactic anticoagulation which is what your treatment will be classed as in the longer term.

You will need to discuss your treatment options with your AME or with the CAA. Unfortunately, there are no medications that will reduce the side effects of ongoing anticoagulant treatment (i.e. bleeding and bruising) except for careful INR-monitoring to ensure that you are within the therapeutic range.

Good luck!

I suspect that you aren't getting much here at the moment :-(

[Martin5345]

Thanks Gingernut well yes I have already been and still am in contact with many specialists and some AME's.

Angiojet has exactly described in which situation I am, and I am more than happy that there are some professional aviation people here who want to share their opinion and knowledge with us. I'm grateful for all your help.

A double PE is a pretty frightening experience, I can tell you now. For statistics I read that the probability of a subsequent infarct is as much as 10%, so I was lucky. Factor V Leiden increases the probability of trombosis 8 times, APS 10 times.

Thanks!

[AngioJet]

I think, as Gingernut has alluded to, that there is little else to recommend you presently, it will be a case of a more thorough XAA review in close liason with your personal AME and possible also your respiratory/cogulation/cardiology consultants.

I wish you the best of luck, don't give up hope of Class I re-certification just yet! You are welcome to PM me should you have any further questions.

[Martin5345]

Actually my AME was not positive, given the extra complications I had, and he would take it to a higher level. Seems like every case is different.

Yes I have heard about Rivaroxaban, but are we allowed to use that? I understand the advantage with Rivaroxaban is that you don't have to adjust your dose according to your INR level, but according to the rules I still have to have my INR monitored on a regular basis.

Yes wondering I read that! Very interesting!
Angiojet, I cannot send you a PM yet as I'm a new member, but thanks for what you said!

[Radgirl]

Martin5345

Just a few points. First, dont worry about 'double' PE. You simply got a clot in the leg(s) called deep vein thrombosis and some bits flew off and got stuck in the lungs. We often see many many clots in the lungs (called pulmonary emboli) and the number is irrelevant once you are over it.

You have been found to have two separate predisposing factors. You will have been checked for high blood pressure and a syndrome called SLE but otherwise there is no need for specific treatment

You will be given anticoagulants until another ultrasound shows the clots in your legs have disappeared - the anticoagulant doesnt dissolve it, merely reduces the risk of more clot. Nature gets rid of it. We dont remove them!!!

We would not in my country continue any treatment although we would restart anticoagulants to cover any operation or immobility. The newer oral anticoagulants such as rivaroxaban are very good as they do not need blood tests, but we wont have 'antidotes' for another 18 months so they can be a problem if you suddenly need surgery, and according to your country, they may not yet be licensed for this particular situation

So if you werent a pilot and lived in Europe, you would be kicked out with no drugs or follow up in a few months. Some US centers do continue anticoagulants but you need to sit down and discuss risk:benefit with your specialist. The risk is of bleeding. Low dose aspirin is an alternative but thought to be ineffective.

Sadly it seems aviation regulators run scared of the risk of further clots, so they apply a OML restriction

Finally, although I regret to say it, please ignore Winnerhofer. Vitamin K is the antidote to your anticoagulant. If you take vitamin K you will reverse its actions and risk a further clot. I presume he is not medically qualified. Sorry to have to say this, but his posts are misleading.

[Martin5345]

Angiojet and Radgirl,

Thanks for your messages and help!

I replied, and I wanted to send you both a private message, but for some reason, my reply hasn't come through and I cannot send you private messages. I don't want everybody to read about my medical and personal details.

Thanks again