Injectable Anticoagulants - Low Molecular Weight Heparins (LMWH)

FRAGMINR(dalteparin) / INNOHEPR (tinzaparin) / LOVENOXR(enoxaparin) / ARIXTRAR(fondaparinux)

Coverage of drugs is first determined by the member’s pharmacy or medical benefit. Please consult with or refer to the Evidence of Coverage document.


X: FDA approved indication
*Sufficient data exists to support off-label use


FDA Approved Indications:

                         Summary of FDA Approved Indications

Indications Fragmin Innohep Lovenox Arixtra
Prophylaxis of DVT that may lead to PE        
In abdominal surgery X   X X
In hip replacement X * X X
In knee replacement * * X X
In patients with severely restricted mobility during acute illness X   X  
In moderate risk surgery patients   *    
In high risk surgery patients * * *  
In orthopedic surgery * *   *
In hip fracture surgery * * * X
In neurosurgery   *    
In major trauma * * *  
In acute spinal cord injury * * *  
In ischemic stroke with impaired mobility * * *  
In general medical patients at risk (CHF, cancer, severe lung disease, restricted to bed) * * * *
In pregnancy related thromboembolism * * *  
Treatment of VTE with warfarin * X X X
Treatment of acute PE with warfarin       X
Extended treatment of symptomatic VTE in patients with cancer X      
Prophylaxis of ischemic complications in unstable agina and non-Q-wave MI X   X *
Acute ST-segment elevated myocardial infarction (STEMI)     X *
Percutaneous angioplasty, acute coronary syndrome * * * *
Anticoagulation for dialysis     *  
Bridging to and from oral anticoagulation     X  


Western Health Advantage Approved Indications and Usage Guidelines:

Western Health Advantage considers the use of low-molecular-weight heparins (LMWHs) medically appropriate in clinical settings in which they have been found to offer improved safety and efficacy over unfractionated heparins (UFHs). Consistent with recommendations from the American College of Chest Physicians conference on antithrombotic and thrombolytic therapy evidence-based guidelines published in Chest.

Western Health Advantage approves coverage of LMWHs for the following indications:

  • Western Health Advantage covers LMWHs consistent with recommendations from the American College of Chest Physicians conference on antithrombotic and thrombolytic therapy evidence-based guidelines published in Chest.
  • Use as short-term, preoperative therapy when a member on oral anticoagulation needs to be put on a drug with a shorter duration of action prior to surgery or as prophylaxis or treatment as a transition to oral anticoagulation
  • Treatment of venous thrombosis and prophylaxis of extension of venous thrombosis when inpatient care can be diverted to an outpatient setting
  • Western Health Advantage discourages the use of Innohep for self administration as it is not available in a pre-drawn syringe and requires the patient to draw up the medication, predisposing the patient to unneeded risks.

Coverage is Not Authorized For:

  • Anticoagulation when there are no known contraindications to oral anticoagulant therapy
  • Patients with low-risk for VTE from surgical procedures not mentioned above
  • Arterial thrombosis except for acute coronary syndrome
  • Femoral-popliteal graft patency
  • Patients with active major bleeding
  • Pregnancy with a mechanical heart valve unless dose adjusted to recommended anti-factor Xa levels
  • Treatment of cancer for reasons other than prevention/treatment of recurrent VTE
  • Subarachnoid hemorrhage
  • Non-FDA approved indications, which are not listed in the Western Health Advantage Approved Indications and Usage Guidelines section unless there is sufficient documentation of efficacy and safety in the published literature



Last review date: July 21, 2016

The site you are transferring to is not hosted by WHA. WHA's Terms of Use and internet Privacy Practices do not apply to your use of this linked site. Please review the policies on privacy and terms of use for the linked site. WHA does not control the accuracy, completeness, or timeliness of the content on the linked site.

Press Esc to cancel

El sitio Web al que está siendo transferido no es provisto por WHA. Las Condiciones de Uso y las Prácticas de Privacidad en Internet de WHA no se aplican a este sitio Web asociado que usted está usando. Revise las políticas sobre la privacidad y condiciones de uso de este sitio Web asociado. WHA no tiene control sobre la exactitud, la totalidad o la actualidad del contenido del sitio Web asociado. WHA no puede garantizar que los servicios de traducción de idiomas estarán disponibles en el sitio vinculado.

Presione «Esc» para cancelar