If a patient with a DVT has active internal bleeding, what alternative treatment should be considered?

In patients with deep vein thrombosis (DVT) who are experiencing active internal bleeding, anticoagulation therapy is contraindicated because it can exacerbate the bleeding. Thrombolysis, while effective in dissolving clots, poses similar risks and is typically reserved for cases where rapid intervention is necessary, and the bleeding risk is managed. Compression stockings can provide symptomatic relief and help prevent post-thrombotic syndrome but do not address the clot itself directly.

The use of an inferior vena cava (IVC) filter becomes particularly relevant in this context. An IVC filter is designed to prevent pulmonary embolism by capturing emboli that may dislodge from the lower extremities. In cases where anticoagulation is not possible due to an active bleeding risk, placement of an IVC filter serves as a valuable alternative to mitigate the risk of embolization while avoiding the complications of anticoagulation. Thus, for a patient with a DVT and active internal bleeding, considering an IVC filter is a prudent approach to manage the risk involved.