Limited Use Note(s) |
|
DALTEPARIN SODIUM15000IU/0.6mL Inj Pref Syr
| Reason For Use Code | Clinical Criteria |
|---|---|
| 186 | For acute treatment of deep venous thrombosis (DVT), for a maximum of three weeks; |
| LU Authorization Period: 1 year | |
| 187 | For DVT in pregnant or lactating females; |
| LU Authorization Period: 1 year | |
| 188 | For DVT in patients whom treatment with warfarin is not tolerated, or contraindicated; |
| LU Authorization Period: 1 year | |
| 189 | For DVT in patients who have failed treatment with warfarin. |
| LU Authorization Period: 1 year |