Anticoagulation case-based scenario

At 70 years of age, Eric has been enjoying more time with his aircraft and aviation-related charitable activities. Eric has held a Private Pilot’s Licence with a Class 2 medical certificate for 32 years.

A few years ago, Eric noted an irregular pulse and palpitations in his chest and went to see his GP who did an ECG (electrocardiogram) and some blood tests. Eric received a diagnosis of atrial fibrillation (AF) and was surprised to hear it was relatively common at his age - around 5% of men his age had it.

Receiving a diagnosis

Eric has enjoyed very good health throughout his life. His GP started him on medication for high blood pressure 7 years ago.

Eric recalled he had a dizzy spell while playing tennis and his GP said this could have been due to AF. Following his diagnosis, Eric’s GP referred him to a cardiologist. By the time Eric arrived at his cardiologist check-up, his irregular heart rhythm returned to normal. His cardiologist thought it would be a good idea he be placed on blood thinners as his AF was likely to recur.

With the AF diagnosis, Aviation Medicine (AvMed) made several changes to Eric’s medical certificate conditions, including:

  • reducing his certificate duration to 12 months
  • requiring a cardiologist report every year.

Experiencing another episode

‘One morning with no warning at all, my heart started racing again,’ Eric said. ‘I saw my GP who told me I was in atrial fibrillation again.’

Eric met with his cardiologist who explained there were 2 broad options in dealing with his condition, including:

  • try to get the heart out of AF by various means
  • leave the heart in AF and use medications to reduce the speed of the heartbeat and blood thinners (anticoagulants) to reduce the risk of stroke.

With no other symptoms, the cardiologist felt confident to try medication. Particularly since Eric had performed well on a 24 hour ECG called a Holter monitor and stress test. The echocardiogram hadn’t changed since he was first diagnosed 2 years ago.

‘Given my age, my hypertension and my AF, my cardiologist started me on tablets - they're from a group of medications called NOAC, or Novel Oral Anticoagulants, to reduce the risk of blood clotting and strokes,’ Eric said. ‘My cardiologist gave me some information on NOAC and many of my friends were already taking it. I was anxious about the impact all this would have on my flying.'

Cleared for flying

Eric contacted his Designated Aviation Medical Examiner (DAME) to inform him of the new diagnosis. The DAME notified AvMed of a change in Eric’s medical condition in accordance with the Civil Aviation Safety Regulations.

The DAME also told Eric not to fly until he received a clearance from either CASA or the DAME himself.

The DAME forwarded copies of the latest cardiologist reports to AvMed with the notification email. Eric started taking his NOAC and provided the DAME with blood test results to forward to AvMed.

After supplying these, Eric received clearance to fly on his Class 2 medical certificate with some minor changes to his requirements.

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