chronic

Superficial Venous Thrombophlebitis

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources4 sources

CHEST Guidelines: Antithrombotic Therapy for VTE Disease 2021 · Diclofenac sodium 50 mg delayed-release (gastro-resistant) tablets US prescribing information, DOSAGE AND ADMINISTRATION (DailyMed SetID a57b897e-0cbe-4ac3-969f-b00357a0cfa8) · Ibuprofen 400 mg film-coated tablets (POM) SmPC section 4.2 (eMC product 7020) · CHEST Antithrombotic Therapy for VTE Disease, second update 2021, superficial vein thrombosis recommendation (as reported in AAFP POEM, Am Fam Physician 2022 Aug)

Verified against5 documents

Diclofenac sodium 50 mg delayed-release (gastro-resistant) tablets US prescribing information, DOSAGE AND ADMINISTRATION (DailyMed SetID a57b897e-0cbe-4ac3-969f-b00357a0cfa8)
Ibuprofen 400 mg film-coated tablets (POM) SmPC section 4.2 (eMC product 7020)
CHEST Antithrombotic Therapy for VTE Disease, second update 2021, superficial vein thrombosis recommendation (as reported in AAFP POEM, Am Fam Physician 2022 Aug)
Superficial Thrombophlebitis - disease-level clinical article (superficial-thrombophlebitis-clinical.txt)
Egyptian National Drug Formulary - Blood 2025

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (3)

A history of preceding trauma such as IV cannulation or infusion of irritant drugs, including recent sclerotherapy, is common
A first episode after age 40 with no other risk factors should raise suspicion for an underlying cancer
Thrombophlebitis that migrates from site to site is a recognized paraneoplastic sign and warrants a cancer work-up

Signs — what you find (2)

A red, warm, tender streak follows the course of the affected superficial vein, often with a palpable cord
Some surrounding swelling or itching can occur, but marked swelling of the whole limb points more to DVT and should prompt ruling that out first [itching]

Tests (7)

Compressive ultrasound is now recommended given how often DVT or PE coexists, since exam alone underestimates the disease extent in up to 77 percent of cases
Ultrasound can confirm the diagnosis, show how far the thrombus extends, and pick up a concurrent DVT
In one study, 23.5 percent of patients with this condition had a concurrent DVT on duplex screening
D-dimer is of limited use here - it is variably raised and cannot separate an isolated case from DVT
Mammography can be considered for Mondor disease, thrombophlebitis of the breast veins, given a reported breast cancer association
One scoring system estimates DVT probability from active cancer, limb edema, age 50 or above, and gives negative points for a ropelike cord or unprovoked onset
Risk bands on that score run from about 1.1 percent DVT likelihood at low probability to 32.3 percent at high probability, though a later study questioned the score's validity

If not this — what else fits (1)

Cellulitis, DVT and other venous thromboembolism, hematoma, lymphangitis, lymphedema, vasculitis, tendonitis or a sports injury, and venous insufficiency are also considered

SourceStatPearls "Superficial Thrombophlebitis" - disease-level clinical article

Presentation findings are traced to the source above.

DICLOFENAC

1st line

Strength50 mg

Formoral.solid

Adult dose and duration

50 mg orally two to three times daily with food x 7-10 days

Paediatric dose

Specialist pediatric hematology referral required.

Dose source

Diclofenac sodium 50 mg delayed-release (gastro-resistant) tablets US prescribing information, DOSAGE AND ADMINISTRATION (DailyMed SetID a57b897e-0cbe-4ac3-969f-b00357a0cfa8)

Why

NSAID that inhibits COX-mediated prostaglandin synthesis to relieve the local pain, redness, and swelling of an inflamed superficial vein; an oral option for superficial thrombophlebitis when there is no cardiovascular contraindication.

Cautions

Do not exceed 150 mg daily; take with food or PPI cover in patients at risk for gastric mucosal damage.
Contraindicated in established ischemic heart disease, peripheral arterial disease, cerebrovascular disease, or severe heart failure.
CONTRAINDICATED in established heart failure (NYHA II-IV), ischaemic heart disease, peripheral arterial disease and cerebrovascular disease. Arterial thrombotic risk rises with dose and duration - use the lowest dose for the shortest time, and never exceed 150 mg a day.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
DECLOFENAC 50MG 20 TAB.	EL NASR	12.00 EGP (0.60/unit)
RHEUMARENE 50MG 20 TAB.	SEDICO	13.50 EGP (0.68/unit)
DICLORAPID 50MG 30 F.C.TAB.	SPIMACO MISR	37.50 EGP (1.25/unit)
ZITOXANAL 50 MG 30 CAPS.	ARAB CAPS > SUECAL PHARMA	69.00 EGP (2.30/unit)
RHUMAQUICK 50 MG 20 DISP. TABS.	MEDIZEN PHARMACEUTICAL INDUSTRIES	21.00 EGP
OFLAM 50 MG 20 QUICKETAB.	MUP > ACINO	48.00 EGP
DECLOPHEN FAST 50MG GR. FOR ORAL SUSP. 30 SACHETS	PHARCO	102.00 EGP
ACTIFAST 50 MG 30 SACHETS	SIGMA > OCTOBER PHARMA	105.00 EGP
CATAFLAM 15MG/ML ORAL DROPS 15 ML? strength differs? different route - not oral solid	NOVARTIS	10.00 EGP
DOLPHIN K 15MG/ML ORAL DROPS 15 ML? strength differs? different route - not oral solid	DELTA PHARMA	11.25 EGP

IBUPROFEN

1st line

Strength400 mg

Formoral.solid

Adult dose and duration

400 mg orally three times daily with food x 10-14 days

Paediatric dose

Superficial vein thrombosis is extremely rare in pediatric patients; urgent pediatric hematology referral is required to investigate underlying hypercoagulability or venous anomalies.

Choice

Sourced preference. The entry's own rationale names ibuprofen the NSAID first choice for a localised superficial thrombophlebitis.

Dose source

Ibuprofen 400 mg film-coated tablets (POM) SmPC section 4.2 (eMC product 7020)

Why

NSAID first-line choice for a localised superficial thrombophlebitis away from the deep venous system; inhibits COX-mediated prostaglandin synthesis to reduce the local inflammation and pain of the thrombosed vein.

Cautions

First-line for a localised superficial thrombophlebitis - short, and not near a deep vein. The distance from the saphenofemoral junction that counts as 'near' is arbitrary and the literature says so: 3 cm and 5 cm are both in use. Treat proximity to the junction as the question, not the exact centimetre.
Perform venous duplex ultrasonography to measure thrombus extent and rule out coexisting deep vein thrombosis (DVT) or proximity to deep venous junctions.
Contraindicated in active peptic ulceration, severe renal impairment, severe heart failure, or third trimester of pregnancy.
Combine with supportive measures including warm compresses, limb elevation, and graduated compression stockings once acute infection/suppuration is excluded.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
DAJUANOFEN 400 MG 20 F.C. TABS.	COPAD PHARMA	5.00 EGP (0.25/unit)
FLABU 400MG 10 F.C.TAB.	DELTA PHARMA	3.75 EGP (0.38/unit)
NOVA-PROFEN 400MG 30 F.C. TABLETS	SANOFI	12.75 EGP (0.42/unit)
IBUPROFEN 400 MG 10 TAB.	SEDICO	6.00 EGP (0.60/unit)
MAFO 400 MG 30 F.C.TABS	EIPICO	42.00 EGP (1.40/unit)
BRUFEN 400 MG 30 TABS.	KAHIRA > ABBOTT LABORATORIES	78.00 EGP (2.60/unit)
PROFUSOL 400MG 20 S.G CAPS.	EUROPEAN EGYPTIAN PHARM. IND.	31.00 EGP
ANALGIPROF 400 MG 25 SACHETS	EVA PHARMA	37.50 EGP
NOVA-PROFEN 100MG/5ML ORAL SUSP. 100ML? strength differs? different route - not oral solid	SANOFI	2.25 EGP
BRUFEMOL-N SUSP. 60 ML? strength differs? different route - not oral solid	ARAB DRUG COMPANY (ADCO)	4.50 EGP

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line

Dose source

Superficial Thrombophlebitis - disease-level clinical article (superficial-thrombophlebitis-clinical.txt)

Why

Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.

Cautions

RED FLAG - Concomitant DVT is common with SVT and ultrasound evaluation is recommended; SVT within 3 cm of the saphenofemoral junction should be treated as DVT.
RED FLAG - A first episode of thrombophlebitis in a patient over 40, or migratory thrombophlebitis, calls for malignancy evaluation.

RIVAROXABAN

2nd line

Strength10 mg

Formoral.solid

Adult dose and duration

10 mg once daily x 45 days

Paediatric dose

Not for children. Superficial thrombophlebitis in a child is uncommon and warrants paediatric assessment rather than anticoagulation in primary care.

Dose source

CHEST Antithrombotic Therapy for VTE Disease, second update 2021, superficial vein thrombosis recommendation (as reported in AAFP POEM, Am Fam Physician 2022 Aug)

Why

The anticoagulant to reach for when the clot is extensive - 5 cm or more, or close to the saphenofemoral junction. CHEST names it alongside fondaparinux as an equal option, and in Egypt the difference is the whole decision: 45 days of rivaroxaban is about 342 EGP in tablets, 45 days of fondaparinux is about 6,219 EGP in daily injections. Same guideline, same recommendation strength, eighteen times the price.

Cautions

Duplex ultrasound before starting. This dose treats superficial vein thrombosis; a coexisting deep vein thrombosis needs the full treatment dose, and starting the low one on an undiagnosed DVT under-treats it.
Contraindicated in active clinically significant bleeding and in severe renal impairment (creatinine clearance under 15 mL/min).
The 10 mg tablet does not need to be taken with food - unlike the 15 mg and 20 mg strengths used for deep vein thrombosis, which do.
Ask about every other anticoagulant and antiplatelet before starting, and about NSAIDs - the two rows above this one are NSAIDs, and the combination raises bleeding risk.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
ANDORIVABAN 10 MG 20 TABS	ANDALOUS PHARMA	152.00 EGP (7.60/unit)
REPATOXABAN 10 MG 10 TABS.	HORUS FOR PHARMACEUTICAL PRODUCTS	105.00 EGP (10.50/unit)
RIVAFLOWVA 10 MG 20 F.C. TABS.	GYPTO PHARMA	210.00 EGP (10.50/unit)
ELIPROXABAN 10 MG 20 F.C. TAB.	SIGMA > SATO PHARMA	260.00 EGP (13.00/unit)
VAROXABAN 10 MG 10 F.C. TAB.	EL-OBOUR	130.00 EGP (13.00/unit)
XANOXIBAN 10 MG 10 F.C. TABS.	HIKMA PHARMA	171.00 EGP (17.10/unit)
XARELTO 10 MG 10 F.C. TAB.	BAYER HEALTHCARE	421.00 EGP (42.10/unit)
RIVABEDAX 10 MG 30 ODT	AVERROES PHARMA	259.50 EGP

FONDAPARINUX

2nd line

Strength2.5 mg

Forminjection

Adult dose and duration

2.5 mg subcutaneously once daily x 30 to 45 days

Paediatric dose

No safety and efficacy data for use in children below 17 years.

Choice

The source names fondaparinux directly - "should receive fondaparinux 2.5 mg/day subcutaneously for 45 days" - so it leads, with rivaroxaban as the alternative.

Dose source

Egyptian National Drug Formulary - Blood 2025

Why

Fondaparinux is recommended by the Cochrane review for higher-risk superficial thrombophlebitis; the formulary lists it for treatment of superficial-vein thrombosis at 2.5 mg daily for up to 45 days.

Cautions

Hypersensitivity to the active substance or to any of the excipients.
Active major bleeding.
Severe renal impairment defined by creatinine clearance < 20 ml/min.
Patients with body weight < 50 kg: has not been studied. Use is not recommended.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
ARIXTRA 2.5MG/0.5ML 10 S.C. PREFILLED SYRINGES	ASPEN PHARMA TRADING LIMITED > PHOENIX GROUP	1382.00 EGP

ENOXAPARIN SODIUM

3rd line

Strength40 mg

Forminjection

Adult dose and duration

40 mg (4000 IU) subcutaneously once daily x 45 days

Paediatric dose

Pediatric venous thrombosis requires immediate specialist pediatric hematology hospital referral.

Dose source

CHEST Antithrombotic Therapy for VTE Disease, second update 2021, superficial vein thrombosis recommendation (as reported in AAFP POEM, Am Fam Physician 2022 Aug)

Why

Third choice, and only where an oral anticoagulant will not do - pregnancy, malabsorption, or a patient who cannot be relied on to swallow it. CHEST suggests fondaparinux 2.5 mg daily over a prophylactic dose of low-molecular-weight heparin, so this is not the guideline's preference. Fondaparinux is registered in Egypt as ARIXTRA 2.5 mg at about 1,382 EGP for 10 syringes, which is 45 daily injections at roughly 6,219 EGP for the course - the reason it is not the first thing offered here either.

Cautions

Mandatory venous duplex ultrasound prior to therapy to document thrombus length >= 5 cm or involvement near saphenofemoral junction.
Contraindicated in active major bleeding, severe heparin-induced thrombocytopenia (HIT) history, or severe uncorrected bleeding diathesis.
Monitor renal function (reduce dose if CrCl < 30 mL/min) and platelet count.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
EXAPINE 40MG/0.4ML 2 PREFILLED SYRINGES	WADI ELNEEL BENTA	185.00 EGP
CLEXANE 40MG/0.4ML 2 PREFILLED SYRINGES	SANOFI	311.00 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.