Limited coverage drugs – dalteparin

Brand name

Dosage form

Strength

Fragmin^®

prefilled syringe (PFS)

• 2,500 IU/0.2 mL
• 5,000 IU/0.2 mL
• 7,500 IU/0.3 mL
• 10,000 IU/0.4 mL
• 12,500 IU/0.5 mL
• 15,000 IU/0.6 mL
• 16,500 IU/0.66 mL
• 18,000 IU/0.72 mL

blister

• 10,000 IU/mL

vial

• 25,000 IU/mL

For the treatment of:

Patients with acute deep vein thrombosis or pulmonary embolus who continue to receive care after leaving an acute care (hospital) setting. This treatment bridges the time gap to achieve therapeutic INR on oral anticoagulants

Up to 10 days' supply

Patients with treatment failure of oral anticoagulant therapy (recurrence of one or more deep vein thromboses or pulmonary emboli in patients with therapeutic INR on oral anticoagulants)

Up to 3 months, then reassessed

Patients with cancer-associated thrombosis

Up to 6 months

For prevention in patients:

Following elective total knee replacement surgery

Up to 14 days

Following elective total hip replacement surgery

Up to 35 days

Following orthopedic surgery for major trauma

Up to 10 days

With lupus anticoagulant syndrome, antiphospholipid syndrome, or thrombophilia

Up to 3 months

Before, during or after pregnancy

Up to 4 weeks post-partum

Following abdominal or pelvic surgery for the management of a malignant tumour (dalteparin and enoxaparin prescriptions only)

Up to 10 days

Following abdominal or pelvic surgery for the management of a malignant tumour (dalteparin and enoxaparin prescriptions only) and who are at high risk (defined as those with previous history of VTE and/or anesthesia lasting longer than 2 hours and/or bed rest lasting 4 days or longer following surgery)

Up to 28 days for high-risk patients