{ "schema_version": 1, "kind": "condition", "id": "pulmonary-embolism-referral", "name": "Pulmonary Embolism (Referral & Outpatient Triage)", "category": "chronic", "sources": "Egyptian National Drug Formulary - Blood Disorder Medications 2025 (enoxaparin monograph) · RIVAROXABAN US prescribing information, Dosage and Administration (DailyMed SetID e62f23c6-89f2-4179-95dc-5732401b3f93)", "review_status": "reviewed", "verified_against": "Egyptian National Drug Formulary - Blood Disorder Medications 2025 (enoxaparin monograph) · RIVAROXABAN US prescribing information, Dosage and Administration (DailyMed SetID e62f23c6-89f2-4179-95dc-5732401b3f93) · Acute Pulmonary Embolism - disease-level clinical article (pulmonary-embolism-referral-clinical.txt)", "verified_date": "2026-08", "treatments": [ { "id": 1513, "generic": "Rivaroxaban", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 15.0, "adult_dose": "15 mg twice daily with food for 21 days, followed by 20 mg once daily with food", "adult_duration": null, "dose_source": "RIVAROXABAN US prescribing information, Dosage and Administration (DailyMed SetID e62f23c6-89f2-4179-95dc-5732401b3f93)", "rationale": "Rivaroxaban is a direct factor Xa inhibitor that anticoagulates the patient to stop the pulmonary embolism from propagating while emergency hospital referral and imaging are arranged.", "cautions": [ "Requires immediate emergency hospital referral for hemodynamic risk stratification and CTPA imaging.", "Must take with meals to ensure reliable bio-availability.", "Contraindicated in severe renal failure (CrCl <15 mL/min).", "Not recommended acutely as an alternative to unfractionated heparin in patients with PE who present with hemodynamic instability or who may receive thrombolysis or pulmonary embolectomy." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Urgent pediatric emergency transfer required", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "REPATOXABAN 15 MG 30 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "HORUS FOR PHARMACEUTICAL PRODUCTS > EVA PHARMA", "price_egp": 360.0, "pack_count": 30, "unit_price": 12.0, "strength_mg": 15.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "RIVAFLOWVA 15 MG 20 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GYPTO PHARMA", "price_egp": 254.0, "pack_count": 20, "unit_price": 12.7, "strength_mg": 15.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "RIVAROSPIRE 15 MG 42 F.C.TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SEDICO > INSPIRE PHARMACEUTICAL COMPANY", "price_egp": 534.0, "pack_count": 42, "unit_price": 12.71, "strength_mg": 15.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "THORMOXIBAN 15 MG 10 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MEDIZEN PHARMACEUTICAL INDUSTRIES", "price_egp": 130.0, "pack_count": 10, "unit_price": 13.0, "strength_mg": 15.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "VAXATO 15 MG 30 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "RAMEDA", "price_egp": 390.0, "pack_count": 30, "unit_price": 13.0, "strength_mg": 15.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "XANOXIBAN 15 MG 50 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "HIKMA PHARMA", "price_egp": 855.0, "pack_count": 50, "unit_price": 17.1, "strength_mg": 15.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "XARELTO 15 MG 14 F.C. TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "BAYER HEALTHCARE", "price_egp": 589.0, "pack_count": 14, "unit_price": 42.07, "strength_mg": 15.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "RIVABEDAX 15 MG 30 ODT", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AVERROES PHARMA", "price_egp": 390.0, "pack_count": null, "unit_price": null, "strength_mg": 15.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "pulmonary-embolism-referral" }, { "id": 1514, "generic": "Enoxaparin sodium", "line": 1, "is_adjunct": false, "form": "injection", "strength_mg": 100.0, "adult_dose": "1.5 mg/kg SC once daily (uncomplicated, low VTE recurrence risk) or 1 mg/kg SC twice daily (obesity, symptomatic PE, cancer, recurrent VTE, or proximal iliac thrombosis)", "adult_duration": "initial emergency stabilization", "dose_source": "Egyptian National Drug Formulary - Blood Disorder Medications 2025 (enoxaparin monograph)", "rationale": "Enoxaparin is a low-molecular-weight heparin that potentiates antithrombin to inhibit factor Xa, providing rapid parenteral anticoagulation for pulmonary embolism while urgent hospital transfer is arranged; it is an alternative to oral rivaroxaban when a parenteral route is preferred.", "cautions": [ "Urgent tertiary care emergency transfer is mandatory.", "Monitor closely for acute hemodynamic collapse or right ventricular strain.", "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." ], "peds_mgkg_low": 1.0, "peds_mgkg_high": 1.5, "peds_max_mg": null, "peds_basis": "dose", "peds_unit": "mg", "peds_note": "Pediatric emergency transfer", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": [ { "weight_kg": 10, "low_mg": 10, "high_mg": 15, "capped": false }, { "weight_kg": 20, "low_mg": 20, "high_mg": 30, "capped": false }, { "weight_kg": 30, "low_mg": 30, "high_mg": 45, "capped": false }, { "weight_kg": 40, "low_mg": 40, "high_mg": 60, "capped": false } ], "brands": [ { "trade_name": "CLEXANE 100MG/ML 2 PREFILLED SYRINGES", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SANOFI", "price_egp": 507.0, "pack_count": null, "unit_price": null, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "pulmonary-embolism-referral" }, { "id": 1515, "generic": "Referral & safety-netting (no drug therapy)", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": null, "adult_duration": null, "dose_source": "Acute Pulmonary Embolism - disease-level clinical article (pulmonary-embolism-referral-clinical.txt)", "rationale": "Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.", "cautions": [ "RED FLAG - Hemodynamic instability is explicitly defined as SBP <90 mmHg, a drop >=40 mmHg from baseline, or a need for vasopressors, and it marks the pathway needing thrombolysis or hospital-level reperfusion rather than routine anticoagulation and transfer.", "RED FLAG - PESI/sPESI risk stratification is the tool that decides who is low-risk enough for outpatient management (rivaroxaban) and who needs hospital care (transfer on enoxaparin).", "RED FLAG - In hemodynamically stable patients with only low clinical suspicion of PE, anticoagulation should generally wait for imaging rather than being started empirically." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": null, "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "pulmonary-embolism-referral" } ] }