Anticoagulation and certification to fly: risks and benefits of different strategies

Atrial fibrillation is a common arrhythmia, especially in the elderly. The presence of atrial fibrillation increases the risk of stroke three- to five fold. This risk largely relates to dilatation of the left side of the heart and a history of previous stroke. Both anticoagulant and antiplatelet ther apy have been shown to reduce the stroke risk with acceptable safety. High- risk patients should receive full dose oral anticoagulation (INR 2.0-3.0) a nd the low-risk patient, antiplatelet therapy. Oral anticoagulation carries a significant risk of bleeding complications, especially when the full dos e regime is applied. Only low-risk individuals with lone atrial fibrillatio n are likely to be eligible for certification to fly and should be limited to multi-crew operation.