# Deep Vein Thrombosis (Referral & Outpatient Stabilization) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: NICE Guideline NG158: Venous thromboembolic diseases 2020 · Egyptian National Drug Formulary - Blood Disorder Medications 2025 (enoxaparin monograph) · Egyptian National Drug Formulary - Blood Disorder Medications 2025 (warfarin monograph) · Egyptian National Drug Formulary - Blood Disorder Medications 2025 (rivaroxaban monograph) - Verified date: 2026-08 ## Verified against - Egyptian National Drug Formulary - Blood Disorder Medications 2025 (rivaroxaban monograph) - Egyptian National Drug Formulary - Blood Disorder Medications 2025 (enoxaparin monograph) - Egyptian National Drug Formulary - Blood Disorder Medications 2025 (warfarin monograph) ## Treatment metadata - Rivaroxaban — 15 mg — oral.solid - Enoxaparin sodium — 100 mg — injection - Warfarin — 5 mg — oral.solid ## Complete treatment card ```text DEEP VEIN THROMBOSIS (REFERRAL & OUTPATIENT STABILIZATION) Sources: NICE Guideline NG158: Venous thromboembolic diseases 2020 · Egyptian National Drug Formulary - Blood Disorder Medications 2025 (enoxaparin monograph) · Egyptian National Drug Formulary - Blood Disorder Medications 2025 (warfarin monograph) · Egyptian National Drug Formulary - Blood Disorder Medications 2025 (rivaroxaban monograph) Review status: REVIEWED against the source listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination RED FLAGS (1) - Wells says likely and no scan within 4 hours - anticoagulate while waiting, do not simply wait SYMPTOMS - what the patient reports (3) - Swelling or pain in one leg - NG158 1.1.1: take a history and examine to exclude other causes before scoring - Ask directly about the risk factors that score: active cancer, recent immobilisation or plaster, bed rest of 3 days or more, major surgery in the last 12 weeks, a previously documented DVT SIGNS - what you find (4) - Tenderness along the line of the deep veins - Whole leg swollen, or calf at least 3 cm larger than the other side - Pitting oedema in the symptomatic leg only [leg swelling] - Non-varicose collateral superficial veins TESTS (2) - D-dimer - but its place depends on the Wells score, so score first (NG158 1.1.2) - Proximal leg vein ultrasound is the test that decides it Score Two-level DVT Wells score - Is a DVT likely enough to scan? Source NICE NG158 Venous thromboembolic diseases: diagnosis, management and thrombophilia testing Status traced to the source above !! MULTI-DRUG REGIMEN - all 2 drugs are given TOGETHER. Not a choice between them. !! the regimen: Enoxaparin sodium + Warfarin 1. RIVAROXABAN [1st line] Adult 15 mg twice daily with food for 21 days, followed by 20 mg once daily with food Peds Specialist pediatric hematology management Source Egyptian National Drug Formulary - Blood Disorder Medications 2025 (rivaroxaban monograph) Why A whole course on its own - no injection and no INR checks. This is the default unless the patient is pregnant, has cancer, or has renal impairment. Caution URGENT hospital referral is required for objective diagnostic confirmation (compression Doppler ultrasonography) and baseline coagulation/renal workup. CONTRAINDICATED in active clinically significant bleeding and severe renal impairment (CrCl <15 mL/min). Must take with food to ensure reliable oral bioavailability of 15 mg and 20 mg strengths. Egypt REPATOXABAN 15 MG 30 TABS. HORUS FOR PHA... 360.00 EGP (12.00/unit) RIVAFLOWVA 15 MG 20 F.C. TABS. GYPTO PHARMA 254.00 EGP (12.70/unit) RIVAROSPIRE 15 MG 42 F.C.TABS. SEDICO > INSP... 534.00 EGP (12.71/unit) THORMOXIBAN 15 MG 10 F.C. TABS. MEDIZEN PHARM... 130.00 EGP (13.00/unit) VAXATO 15 MG 30 TABS. RAMEDA 390.00 EGP (13.00/unit) XANOXIBAN 15 MG 50 F.C. TABS. HIKMA PHARMA 855.00 EGP (17.10/unit) XARELTO 15 MG 14 F.C. TAB. BAYER HEALTHCARE 589.00 EGP (42.07/unit) RIVABEDAX 15 MG 30 ODT AVERROES PHARMA 390.00 EGP 2. ENOXAPARIN SODIUM [1 of 2 - GIVE ALL TOGETHER] Adult 1 mg/kg subcutaneously twice daily (or 1.5 mg/kg subcutaneously once daily) - On average, treatment is prescribed for 7- 10 days. Peds 1-1.5 mg/kg/dose (Safety and efficacy in the paediatric population not established. Literature-based therapeutic regimen: child 1 month: 1.5 mg/kg twice daily; child 2 months–17 years: 1 mg/kg twice daily.) 3kg -> 3-4.5 mg/dose 4kg -> 4-6 mg/dose 5kg -> 5-7.5 mg/dose 6kg -> 6-9 mg/dose 7kg -> 7-10.5 mg/dose 8kg -> 8-12 mg/dose 9kg -> 9-13.5 mg/dose 10kg -> 10-15 mg/dose 11kg -> 11-16.5 mg/dose 12kg -> 12-18 mg/dose 13kg -> 13-19.5 mg/dose 14kg -> 14-21 mg/dose 15kg -> 15-22.5 mg/dose 16kg -> 16-24 mg/dose 17kg -> 17-25.5 mg/dose 18kg -> 18-27 mg/dose 19kg -> 19-28.5 mg/dose 20kg -> 20-30 mg/dose 21kg -> 21-31.5 mg/dose 22kg -> 22-33 mg/dose 23kg -> 23-34.5 mg/dose 24kg -> 24-36 mg/dose 25kg -> 25-37.5 mg/dose 26kg -> 26-39 mg/dose 27kg -> 27-40.5 mg/dose 28kg -> 28-42 mg/dose 29kg -> 29-43.5 mg/dose 30kg -> 30-45 mg/dose 31kg -> 31-46.5 mg/dose 32kg -> 32-48 mg/dose 33kg -> 33-49.5 mg/dose 34kg -> 34-51 mg/dose 35kg -> 35-52.5 mg/dose 36kg -> 36-54 mg/dose 37kg -> 37-55.5 mg/dose 38kg -> 38-57 mg/dose 39kg -> 39-58.5 mg/dose 40kg -> 40-60 mg/dose 41kg -> 41-61.5 mg/dose 42kg -> 42-63 mg/dose 43kg -> 43-64.5 mg/dose 44kg -> 44-66 mg/dose 45kg -> 45-67.5 mg/dose 46kg -> 46-69 mg/dose 47kg -> 47-70.5 mg/dose 48kg -> 48-72 mg/dose 49kg -> 49-73.5 mg/dose 50kg -> 50-75 mg/dose Source Egyptian National Drug Formulary - Blood Disorder Medications 2025 (enoxaparin monograph) Why The start of the warfarin regimen, not a treatment on its own. Stopping it at 5-10 days without warfarin running leaves a three-month clot anticoagulated for a week. Caution In pregnancy and in active cancer, enoxaparin is used alone for the full course - warfarin is teratogenic and performs poorly in cancer. That is the one situation where this drug is the whole treatment. Monitor platelet count for heparin-induced thrombocytopenia (HIT). Dose adjustment is required in renal impairment (CrCl <30 mL/min: 1 mg/kg once daily). Which regimen: 1.5 mg/kg once daily is for an uncomplicated patient at low risk of recurrence. Use 1 mg/kg twice daily in obesity, symptomatic PE, cancer, recurrent VTE, or proximal iliac thrombosis. Severe renal impairment (creatinine clearance 15-30 mL/min): reduce to 1 mg/kg ONCE daily. Below 15 mL/min it is not recommended. Enoxaparin accumulates when clearance falls and the consequence is bleeding. End stage renal disease (CrCl < 15 mL/min): Use is not recommended. Egypt CLEXANE 100MG/ML 2 PREFILLED SYRINGES SANOFI 507.00 EGP 3. WARFARIN [2 of 2 - GIVE ALL TOGETHER] Adult 2 to 10 mg once daily initially, chosen by weight, age and general health, then adjusted according to INR (target 2.0-3.0); co-administer LMWH for at least 5 days until INR is >=2.0 for 24 hours Peds Specialist pediatric hematology titration Source Egyptian National Drug Formulary - Blood Disorder Medications 2025 (warfarin monograph) Why Takes days to work, which is why the injection overlaps it. Do not stop the enoxaparin on the day warfarin starts. Caution Target INR is 2.0-3.0 (target 2.5); mandatory regular INR monitoring and dose titration. Extensive cytochrome P450 drug interactions and dietary Vitamin K sensitivity; maintain consistent dietary greens intake and verify all concurrent medications. Warfarin is contraindicated in the first trimester and during the last four weeks of pregnancy. Egypt HAEMOFARIN 5MG 100 TAB. EL NASR 11.00 EGP (0.11/unit) MARIVANIL 5MG 50 TAB. EL NILE. 5.60 EGP (0.11/unit) MAREVAN 5 MG 102 TABS. GLAXO SMITHKLINE 78.00 EGP (0.76/unit) COUMADIN 5 MG 28 TABLETS (ILLEGAL IMPORT) ZENTIVA > 31.00 EGP (1.11/unit) Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)