Dawaa Reference

Clinical reference

Deep Vein Thrombosis (Referral & Outpatient Stabilization)

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

Evidence status

Checked against the sources named below

Sources4 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 against3 documents
  • 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)

Verified date2026-08

Presentation reference

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

Scores

  • Two-level DVT Wells score — Is a DVT likely enough to scan?

SourceNICE NG158 Venous thromboembolic diseases: diagnosis, management and thrombophilia testing

Presentation findings are traced to the source above.

Combination safety

Combination regimens

!! MULTI-DRUG REGIMEN - all 2 drugs are given TOGETHER. Not a choice between them.

!! the regimen: Enoxaparin sodium + Warfarin

1

RIVAROXABAN

1st line

Strength15 mg

Formoral.solid

Adult dose and duration

15 mg twice daily with food for 21 days, followed by 20 mg once daily with food

Paediatric dose

Specialist pediatric hematology management

Dose 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.

Cautions
  • 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.
Egyptian brands
Egyptian brandManufacturerIndicative price
REPATOXABAN 15 MG 30 TABS.HORUS FOR PHARMACEUTICAL PRODUCTS > EVA PHARMA360.00 EGP (12.00/unit)
RIVAFLOWVA 15 MG 20 F.C. TABS.GYPTO PHARMA254.00 EGP (12.70/unit)
RIVAROSPIRE 15 MG 42 F.C.TABS.SEDICO > INSPIRE PHARMACEUTICAL COMPANY534.00 EGP (12.71/unit)
THORMOXIBAN 15 MG 10 F.C. TABS.MEDIZEN PHARMACEUTICAL INDUSTRIES130.00 EGP (13.00/unit)
VAXATO 15 MG 30 TABS.RAMEDA390.00 EGP (13.00/unit)
XANOXIBAN 15 MG 50 F.C. TABS.HIKMA PHARMA855.00 EGP (17.10/unit)
XARELTO 15 MG 14 F.C. TAB.BAYER HEALTHCARE589.00 EGP (42.07/unit)
RIVABEDAX 15 MG 30 ODTAVERROES PHARMA390.00 EGP
2

ENOXAPARIN SODIUM

Regimen: dvt-lmwh-warfarin

1 of 2 - GIVE ALL TOGETHER

Strength100 mg

Forminjection

Adult dose and duration

1 mg/kg subcutaneously twice daily (or 1.5 mg/kg subcutaneously once daily) - On average, treatment is prescribed for 7- 10 days.

Paediatric dose

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.)

Dose by weight
3kg3-4.5 mg/dose
4kg4-6 mg/dose
5kg5-7.5 mg/dose
6kg6-9 mg/dose
7kg7-10.5 mg/dose
8kg8-12 mg/dose
9kg9-13.5 mg/dose
10kg10-15 mg/dose
11kg11-16.5 mg/dose
12kg12-18 mg/dose
13kg13-19.5 mg/dose
14kg14-21 mg/dose
15kg15-22.5 mg/dose
16kg16-24 mg/dose
17kg17-25.5 mg/dose
18kg18-27 mg/dose
19kg19-28.5 mg/dose
20kg20-30 mg/dose
21kg21-31.5 mg/dose
22kg22-33 mg/dose
23kg23-34.5 mg/dose
24kg24-36 mg/dose
25kg25-37.5 mg/dose
26kg26-39 mg/dose
27kg27-40.5 mg/dose
28kg28-42 mg/dose
29kg29-43.5 mg/dose
30kg30-45 mg/dose
31kg31-46.5 mg/dose
32kg32-48 mg/dose
33kg33-49.5 mg/dose
34kg34-51 mg/dose
35kg35-52.5 mg/dose
36kg36-54 mg/dose
37kg37-55.5 mg/dose
38kg38-57 mg/dose
39kg39-58.5 mg/dose
40kg40-60 mg/dose
41kg41-61.5 mg/dose
42kg42-63 mg/dose
43kg43-64.5 mg/dose
44kg44-66 mg/dose
45kg45-67.5 mg/dose
46kg46-69 mg/dose
47kg47-70.5 mg/dose
48kg48-72 mg/dose
49kg49-73.5 mg/dose
50kg50-75 mg/dose
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.

Cautions
  • 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.
Egyptian brands
Egyptian brandManufacturerIndicative price
CLEXANE 100MG/ML 2 PREFILLED SYRINGESSANOFI507.00 EGP
3

WARFARIN

Regimen: dvt-lmwh-warfarin

2 of 2 - GIVE ALL TOGETHER

Strength5 mg

Formoral.solid

Adult dose and duration

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

Paediatric dose

Specialist pediatric hematology titration

Dose 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.

Cautions
  • 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.
Egyptian brands
Egyptian brandManufacturerIndicative price
HAEMOFARIN 5MG 100 TAB.EL NASR11.00 EGP (0.11/unit)
MARIVANIL 5MG 50 TAB.EL NILE.5.60 EGP (0.11/unit)
MAREVAN 5 MG 102 TABS.GLAXO SMITHKLINE78.00 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.