78 y/o male with remote history of GI bleeding and IVC filter placement for treatment of previous DVT/PE presents with acute right leg swelling. Doppler notes recurrent DVT. What is the treatment?

Reevaluate the initial contraindication to anticoagulation and purpose for IVC filter placement, in this case GI bleeding, and determine whether the contraindication still exists or can be mitigated.   If the patient can be anticoagulated, he should be.  An IVC filter should not be viewed as an equivalent substitute to anticoagulation in the setting of acute VTE and is certainly not an “insurance policy” against subsequent PE.  Small thrombi are capable of passing through patent filters or through collaterals around obstructed filters; furthermore, direct thrombus extension can occur through the filter itself.


Source

Greer, J.  Wintrobe's Clinical Hematology.  12 ed.  2008.

Fedullo, P.  "Inferior vena cava filters"  Up to Date.  Jan 2012.

Nanda, S.  "Inferior Vena Cava Anomalies - A Common Cause of DVT and PE Commonly Not Diagnosed"  American Journal of the Medical Sciences.   May 2008.