Decision Considerations
Disease Protocols - Thromboembolic Disease

An applicant with a history of thromboembolic disease must submit the following if consideration for medical certification is desired:

1. Hospital admission and discharge summary
2. Current status report including:
   • Detailed family history of thromboembolic disease
   • Neoplastic workup, if clinically indicated
   • Any blood clotting disorder (e.g. PT/PTT, Protein S and C, Factor V Leiden); AND
   • If still anticoagulated with warfarin (Jantoven), submit all (no less than monthly) INRs from time of hospital discharge to present

   Warfarin (Jantoven): For applicants who are just beginning warfarin (Jantoven) treatment the following is required:

   • Minimum observation time of 6 weeks after initiation of warfarin therapy;
   • Must also meet any required observation time for the underlying condition; AND
   • 6 INRs, no more frequently than 1 per week

   NOAC/DOACs: For applicants who are just beginning treatment with NOAC/DOACs, the following is required:

   • Minimum observation time of 2 weeks after initiation of therapy; AND
   • Must also meet any required observation time for the underlying condition