Correctional officer on Xarelto

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Dcsmd

Correctional officer on Xarelto

Post by Dcsmd » Thu Aug 13, 2015 5:01 pm

Good Afternoon,

I did a physical on a Correctional Officer (Corporal), that although he has a rank, is still expected to have contact with inmates with risk of physical confrontation. He is on Xarelto for chronic AFib and I placed job restrictions: specifically no contact with inmates or work in situations with risk of personal confrontation / trauma due to increased risk of bleeding, especially intracerebral.

His cardiologist is writing letters stating he can perform his duties. His county employer has no specific guidelines for the members (they have California POST for Police and Corrections pre-employment only). I'm using best medical judgement and LEO guidelines, since he is considered law enforcement, using weapon and with high risk pay differential.

Is there any literature that you know of that would state otherwise? Please give me your opinion.

Thank you,

DCSMD



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Re: Correctional officer on Xarelto

Post by Robert Swotinsky MD » Fri Aug 14, 2015 9:58 pm

As the post indicates, the ACOEM Guidance for the Medical Evaluation of Law Enforcement Officers states that use of anticoagulants is cause for assignment to restricted duty because the medication may cause significant bleeding (particularly intracranial) resulting in sudden incapacitation in case of an altercation or fall. Although corrections officers are not law enforcement officers, the physical demands of their jobs are more similar than different. In Massachusetts, where I practice, the retirement board has made it policy to apply police medical standards to correctional officers. Like the ACOEM Guidance, the Massachusetts Medical Standards for Municipal Police Officers states that chronic anticoagulation therapy is disqualifying. The California Peace Officer standards likewise make chronic anticoagulation including use of direct Factor Xa inhibitors like Xarelto use a disqualifier due to the risk of bleeding with trauma.

The post by DCSMD indicates the intent to apply (ACOEM) police standards to this particular case. I don't think one can fault DCSMD for taking this approach. I know of no literature establishing that use of this medication is NOT a disqualifier and that it does NOT place the user at increased risk of significant harm.

Dcsmd

Re: Correctional officer on Xarelto

Post by Dcsmd » Mon Aug 17, 2015 8:34 am

Thank you.

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