# Superficial Venous Thrombophlebitis - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - 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 date: 2026-08 ## Verified against - 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 ## Treatment metadata - Diclofenac — 50 mg — oral.solid - Ibuprofen — 400 mg — oral.solid - Referral & safety-netting (no drug therapy) - Rivaroxaban — 10 mg — oral.solid - Fondaparinux — 2.5 mg — injection - Enoxaparin sodium — 40 mg — injection ## Complete treatment card ```text SUPERFICIAL VENOUS THROMBOPHLEBITIS 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) Review status: REVIEWED against 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 (2026-08) 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 Source StatPearls "Superficial Thrombophlebitis" - disease-level clinical article Status traced to the source above 1. DICLOFENAC [1st line] Adult 50 mg orally two to three times daily with food x 7-10 days Peds Specialist pediatric hematology referral required. 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. Caution 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. Egypt 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 > S... 69.00 EGP (2.30/unit) RHUMAQUICK 50 MG 20 DISP. TABS. MEDIZEN PHARM... 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 > OCTOB... 105.00 EGP CATAFLAM 15MG/ML ORAL DROPS 15 ML NOVARTIS 10.00 EGP -> ? strength differs, ? different route - not oral solid DOLPHIN K 15MG/ML ORAL DROPS 15 ML DELTA PHARMA 11.25 EGP -> ? strength differs, ? different route - not oral solid 2. IBUPROFEN [1st line] Adult 400 mg orally three times daily with food x 10-14 days Peds 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. 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. Caution 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. Egypt 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 > ABBO... 78.00 EGP (2.60/unit) PROFUSOL 400MG 20 S.G CAPS. EUROPEAN EGYP... 31.00 EGP ANALGIPROF 400 MG 25 SACHETS EVA PHARMA 37.50 EGP NOVA-PROFEN 100MG/5ML ORAL SUSP. 100ML SANOFI 2.25 EGP -> ? strength differs, ? different route - not oral solid BRUFEMOL-N SUSP. 60 ML ARAB DRUG COM... 4.50 EGP -> ? strength differs, ? different route - not oral solid 3. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult 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. Caution 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. 4. RIVAROXABAN [2nd line] Adult 10 mg once daily x 45 days Peds Not for children. Superficial thrombophlebitis in a child is uncommon and warrants paediatric assessment rather than anticoagulation in primary care. 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. Caution 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. Egypt ANDORIVABAN 10 MG 20 TABS ANDALOUS PHARMA 152.00 EGP (7.60/unit) REPATOXABAN 10 MG 10 TABS. HORUS FOR PHA... 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 ... 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 5. FONDAPARINUX [2nd line] Adult 2.5 mg subcutaneously once daily x 30 to 45 days Peds 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. 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. Caution 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. Egypt ARIXTRA 2.5MG/0.5ML 10 S.C. PREFILLED SYRINGES ASPEN PHARMA TRADING LIMI... 1382.00 EGP 6. ENOXAPARIN SODIUM [3rd line] Adult 40 mg (4000 IU) subcutaneously once daily x 45 days Peds Pediatric venous thrombosis requires immediate specialist pediatric hematology hospital referral. 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. Caution 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. Egypt 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. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)