Guide for Aviation Medical Examiners

Pharmaceuticals (Therapeutic Medications)
Anticoagulants

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

For Non-Valvular Atrial Fibrillation (AFib), See Emboli Mitigation (PDF)

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:

   Warfarin (Coumadin):
   For applicants who are just beginning warfarin (Coumadin) 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
     • Minimum observation time of 2 weeks after initiation of therapy; AND
     • Must also meet any required observation time for the underlying condition
        

   For applicants who are on an established use of warfarin (Coumadin), status report from the treating physician should address and include:

   • Drug dose history and schedule;
   • Comment regarding side effects; AND
   • A minimum of monthly International Normalized Ratio (INRs) results for the immediate prior 6 months.