Xarelto and DOT exams

[swooshie1]

Patient anti-coagulated on Xarelto (DVT x 2, being worked up for Protein C, S, etc):  I don't see anything in the FMCSA Med Examiner handbook / guidelines regarding Xarelto specifically and guidance on timelines, etc.  My thought is to confirm compliance with med with prescribing provider, one year cert with cardiology f/u ??  How are the rest of you approaching this?

 

thanks!

[rev ronin]

1 year with prescribing provider letter certifying that the patient is OK to operate commercial vehicles sounds about right.

[swooshie1]

Thank you!

[Reality Check 2]

The key on these issues is to evaluate the underlying condition for its threat status to the safety of the driver.

 

1. If the driver had a DVT/PE and is on 3 months anti-coag then they need to be monitored for resolution. Cert this driver for 3 or 6 months and get follow up notes from specialist releasing them from anticoag

 

2. If this is a multiple PE or the patient has Factor V Leiden and faces lifetime anticoag then you have to assess risk of sudden debilitation from the med or the condition. Cert this driver for a year at max forever.

 

3. If a driver has had a DVT/PE ON MEDICATION then there should be large red flags. A driver sits for prolonged periods of time and has increased risk of DVT overall and a PE could be suddenly debilitating. I would not certify this driver due to risk of sudden incapacitation. If they have a pulmonologist/hematologist who insists they might be stable then I might (maybe but unlikely) consider a 6 month card and then a 1 year card with constant monitoring by specialist.

 

Always evaluate the condition that necessitates the medication as it is the root of the problem. The medication might have side effects or might not be the right treatment or just a very dangerous bandaid on top of a root problem.

 

Just my thoughts 

[Sticks]

Interesting topic. Thanks for sharing.

 

By the way, is FMCSA certification required to perform all DOT physicals? I've heard of clinics having physicians and mid-levels doing them without certification for intrastate, not interstate, drivers. Sounds fishy to me.

[probasestealer]

The key on these issues is to evaluate the underlying condition for its threat status to the safety of the driver.

 

1. If the driver had a DVT/PE and is on 3 months anti-coag then they need to be monitored for resolution. Cert this driver for 3 or 6 months and get follow up notes from specialist releasing them from anticoag

 

2. If this is a multiple PE or the patient has Factor V Leiden and faces lifetime anticoag then you have to assess risk of sudden debilitation from the med or the condition. Cert this driver for a year at max forever.

 

3. If a driver has had a DVT/PE ON MEDICATION then there should be large red flags. A driver sits for prolonged periods of time and has increased risk of DVT overall and a PE could be suddenly debilitating. I would not certify this driver due to risk of sudden incapacitation. If they have a pulmonologist/hematologist who insists they might be stable then I might (maybe but unlikely) consider a 6 month card and then a 1 year card with constant monitoring by specialist.

 

Always evaluate the condition that necessitates the medication as it is the root of the problem. The medication might have side effects or might not be the right treatment or just a very dangerous bandaid on top of a root problem.

 

Just my thoughts 

Awesome response.

[Guest UVAPAC]

The key on these issues is to evaluate the underlying condition for its threat status to the safety of the driver.

 

1. If the driver had a DVT/PE and is on 3 months anti-coag then they need to be monitored for resolution. Cert this driver for 3 or 6 months and get follow up notes from specialist releasing them from anticoag

 

2. If this is a multiple PE or the patient has Factor V Leiden and faces lifetime anticoag then you have to assess risk of sudden debilitation from the med or the condition. Cert this driver for a year at max forever.

 

3. If a driver has had a DVT/PE ON MEDICATION then there should be large red flags. A driver sits for prolonged periods of time and has increased risk of DVT overall and a PE could be suddenly debilitating. I would not certify this driver due to risk of sudden incapacitation. If they have a pulmonologist/hematologist who insists they might be stable then I might (maybe but unlikely) consider a 6 month card and then a 1 year card with constant monitoring by specialist.

 

Always evaluate the condition that necessitates the medication as it is the root of the problem. The medication might have side effects or might not be the right treatment or just a very dangerous bandaid on top of a root problem.

 

Just my thoughts 

 

Agreed this response is about as good as it gets.

 

Our office has a standard form that we send to treating providers to address medical conditions like DVT/PE

 

Essentially it asks 3 questions pertaining to the above listed medical condition, in this case DVT/PE

 

1.  Please provide documentation that the above condition is controlled.

2.  List all medications prescribed to treat this condition, do any of these medications have side effects which could impair ability to drive?

3.  In your professional medical opinion, is the above listed patient in your opinion safe to operate a commercial motor vehicle based on the condition which you treat them for?

 

 

Ultimately even with this note, FMCSA makes it very clear that ultimately YOU are responsible for certifying the driver, however it is always nice to have a specialist weigh in