Generic Name / Strength / Form |
Fraxiparine / 2,850 Iu(Anti-Xa)/0.3 mL / SYRINGE |
Fraxiparine / 3,800 Iu(Anti-Xa)/0.4 mL / SYRINGE |
Fraxiparine / 5,700 Iu(Anti-Xa)/0.6 mL / SYRINGE
|
Fraxiparine / 9,500 Iu(Anti-Xa)/0.3 mL / SYRINGE |
Fraxiparine / 11,400 Iu(Anti-Xa)/0.6 mL / SYRINGE |
Fraxiparine / 15,200 Iu(Anti-Xa)/0.8 mL / SYRINGE |
Fraxiparine / 19,000 Iu(Anti-Xa)/1 mL / SYRINGE |
Criteria |
Approval period (to complete the balance of a total duration of therapy for outpatients) |
---|---|
Treatment of venous thromboembolism | |
1. Treatment of acute deep vein thrombosis or pulmonary embolus continued from an acute care (hospital) setting to bridge time to achieve therapeutic INR on oral anticoagulants. | 1. Up to 10 days supply |
OR | |
2. Following failure on oral anticoagulant therapy (recurrence of one or more deep vein thromboses or pulmonary emboli in patients with therapeutic INR on oral anticoagulants). | 2. Up to 3 months, then reassessed |
OR | |
Prophylaxis of venous thromboembolism | |
3. Following elective total knee replacement surgery. | 3. Up to 14 days |
OR | |
4. Following elective total hip replacement surgery. | 4. Up to 35 days |
OR | |
5. Following orthopedic surgery for major trauma. | 5. Up to 10 days |
OR | |
6. Concurrent lupus anticoagulant syndrome, antiphospholipid syndrome, or thrombophilia. | 6. Up to 3 months |
OR | |
7. Associated with pregnancy. | 7. Up to 4 weeks post-partum. |
PharmaCare coverage will be provided for a patient who meets the Limited Coverage criteria, and whose prescription is written by an orthopedic surgeon who has entered into a Collaborative Prescribing Agreement.
Due to the individual nature of each Collaborative Prescribing Agreement, the Agreement must be signed by the prescriber and not his/her delegate.