QUESTION: Is Xarelto an approved blood thinner? 

ANSWER: Blood “thinners” are used to treat a range of conditions such as preventing clotting when one has atrial fibrillation (a cardiac rhythm disorder), when a heart valve has been implanted, when one has suffered a deep vein thrombosis, or in the face of various inherited clotting conditions. They work by interfering with the natural mechanism of clotting in a variety of ways. Xarelto – or to call by its chemical name, Rivaroxaban – one such blood thinner, is allowable, but one also needs to know what the underlying condition is and whether that might be disqualifying. Please see this link to the AOPA medication database:


QUESTION: I was diagnosed with tremor onset Parkinson’s disease seven years ago. I had a deep brain stimulator installed four years ago for the tremor and it worked great. I have no cognitive issues, play golf, drive a car, fly the plane fine with an instructor. I’m not on any medication. Do you think it would be wise to apply for the self-certifying third-class medical?

ANSWER: We covered this topic very recently in the pages of AOPA Pilot magazine (Sparring with Parkinson’s, August 2017, page 26). In that article we addressed not only the disease and FAA aspects, but also the game-changing technology that you benefited from, deep brain stimulation. You might qualify for a third-class medical if you wanted to go that route, but it wouldn’t be painless by any means! FAA will want all the usual records, including current neuro evaluation, all the imaging reports, history, and current status. I gather that when you say “self-certifying third-class medical,” you are referring to BasicMed, the alternative medical self-assessment to a regular third-class medical. Your best bet is BasicMed because of the bureaucracy that will be involved if you go the third-class medical route. It’s been four years, so you have good follow-up history, too.


QUESTION: I recently suffered a mild heart attack and an angiogram showed that my cardiac vessels were clear and the heart seemed to be working well. I was prescribed Toprol and aspirin for premature ventricular contractions, which I’ve had all my life. My third-class medical was issued at the end of October 2016 and I am 81 years old. Not ready to quit just yet! What should I do now?

ANSWER: Because of your history of a myocardial infarction, you will need to apply for a special issuance authorization from the FAA. For third-class medical consideration, there is no wait time after the event, so whenever your cardiologist is comfortable with setting you up for a stress test, you can start the process. Below is a link to our online information that will detail the process and what you will need in the way of testing and hospital records. You don’t need to see your aviation medical examiner since you had a flight physical in 2016 that doesn’t expire until 2018 – and remember, age in and of itself is not a limiting factor!


QUESTION: What is the current FAA thinking about minor stroke? 

ANSWER: A stroke is basically the brain equivalent of a heart attack and occurs when an area of the brain loses blood supply due to either blockage in an artery or bleeding from a vessel. The resulting damage leads to impairments in sensation, movement, speech, mental function, or even death.

In the FAA’s regulatory world of medical certification policy, a cerebrovascular accident (CVA) usually refers to a stroke or TIA (transient ischemic attack). In the “clinical” world, neurologists look at these types of conditions with a bit more granularity than does the FAA. Regulatory medicine requires that the condition be evaluated for risk of incapacitation during the period the medical certificate would be in effect; usually one year for most discretionary special issuances. Without the benefit of the magic crystal ball, risk assessment must be made on the basis of “evidence.” The evidence is extracted from existing literature about, in your case, stroke, and the likelihood of recurrence after the first event, and potential for “residual neurological deficits” in cognitive function that could linger long after the initial symptoms have resolved.

Currently, the FAA requires in most cases of stroke or TIA a recovery period of 24 months! Yes, that is correct, two years of recovery to allow as much time as possible for the nervous system to regenerate and for any neurological deficits to resolve to whatever the new baseline becomes as a result of the brain insult. After the two-year recovery period, the FAA also requires a comprehensive neurological and neurocognitive evaluation to assess the effects of the stroke and the extent of recovery and of residual deficits. 

The good news is that many pilots are able to regain medical certification after a CVA; however, the road to recertification does come with some hefty evaluation requirements. So as is usually the case, prevention beats dealing with the consequences; control diet and weight, exercise regularly, check blood pressure and blood fat content, and have regular check-ups.

Portrait of Gary Crump, AOPA's director of medical certification with a Cessna 182 Skylane at the National Aviation Community Center.
Frederick, MD USA
Gary Crump
Gary is the Director of AOPA’s Pilot Information Center Medical Certification Section and has spent the last 32 years assisting AOPA members. He is also a former Operating Room Technician, Professional Firefighter/Emergency Medical Technician, and has been a pilot since 1973.

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