Guide for Aviation Medical Examiners

• Print

Pharmaceuticals (Therapeutic Medications)
Anticoagulants

1. Code of Federal Regulations:
• First-Class Airman Medical Certificate: 67.113(b)(c)
• Second-Class Airman Medical Certificate: 67.213(b)(c)
• Third-Class Airman Medical Certificate: 67.313(b)(c)


2. Medical History: Item 18.g. Heart or vascular trouble.
   The applicant should describe the condition to include, dates, symptoms, treatment, and provide medical reports to assist in the certification decision-making process. These reports should include, as indicated by the applicable underlying condition(s) and class applied for: 24-hour Holter monitor, operative reports of any coronary intervention (including the original cardiac catheterization report), stress tests (including worksheets and original tracings or a legible copy). For myocardial perfusion imaging, we require the interpretive report and copies of the actual images in both grey-scale and color (in digital format or hard copy.) Per Part 67, for all classes of medical certificates, there is cause for denial if there is an established medical history or clinical diagnosis of myocardial infarction, angina pectoris, cardiac valve replacement, permanent cardiac pacemaker implantation, heart replacement, or coronary heart disease that has required treatment (or if untreated, that has been symptomatic or clinically significant).


3. Aeromedical Decision Considerations:
   See Item 36, Heart, Aerospace Medical Disposition table


4. Protocol:
   As per the specific underlying condition(s), see Disease Protocols.


5. Pharmaceutical Considerations:
   For applicants using warfarin (Coumadin), the status report from the treating physician should address drug dose history and schedule, comment regarding side effects, and include a minimum of monthly International Normalized Ratio (INR) results for the immediate prior 6 months.