The treatment of choice in recurrent venous thrombosis leading to pulmonary embolism despite intensive anticoagulation is:
Fibrinolysis treatment with tissue plasminogen activator
Pulmonary embolectomy
Pulmonary thromboendaerectomy
Inferior vena caval filters
The two indications for inseion of an IVC filter are (1) active bleeding that precludes anticoagulation and (2) recurrent venous thrombosis despite intensive anticoagulation. Ref: Harrisons Principles of Internal Medicine, 18th Edition, Page 2176.