In the last couple of years, the Food and Drug Administration (FDA) has approved several new medications that fall in the “anticoagulant,” or blood thinning genre. These new drugs were developed to compete with warfarin (Coumadin) that has been the work horse anticoagulant for many years and has been used to treat many conditions such as pulmonary embolism, deep vein thrombosis, cardiac valve replacement, and atrial fibrillation (a heart arrhythmia).
The medications are Pradaxa (dabigatran), Xarelto (rivaroxaban) and, just recently, Eliquis (apixaban). However, Pradaxa, approved by the FDA in 2010, is not an FAA-allowed medication, and probably won’t be for some time. You may recall from previous articles by Dr. Warren Silberman that the FAA, by policy, observes any new FDA-approved medications for at least one year before considering those medications for aviation duties. During that observation period when Pradaxa was being evaluated, the FDA noted some serious bleeding problems in some patients that could not be reversed, so that factor alone gave the FAA reason to determine that it wasn’t an appropriate medication for use in aviation.
For Xarelto and Eliquis, there are advantages and benefits for many patients, the most noticeable being that frequent blood testing to determine the INR (International Normalized Ratio) that determines the appropriate dosing and frequency of use is not needed. That reduces the cost and the amount of information needed to renew the authorization each time.
The FAA probably won’t suggest this in any letters to airmen, but if you are currently on warfarin, you might want to discuss with your treating physician changing to either Xarelto or Eliquis if your medical condition warrants it.