What is the next appropriate step for a patient with PE or DVT when anticoagulation therapy is contraindicated?

• A. Start thrombolytics
• B. Place IVC filter
• C. Begin compression therapy
• D. Administer INR screening

Answer: (B)

When anticoagulation therapy is contraindicated in a patient with pulmonary embolism (PE) or deep vein thrombosis (DVT), the next appropriate step is to place an inferior vena cava (IVC) filter. An IVC filter serves as a mechanical barrier to prevent thrombi (blood clots) from migrating from the lower limbs to the pulmonary circulation, thereby reducing the risk of a PE. This intervention is particularly valuable for patients with contraindications to anticoagulation, such as active bleeding, recent surgeries, or certain coagulopathies, where the risks of anticoagulants outweigh the benefits.

In contrast, thrombolytic therapy is not indicated in patients who cannot receive anticoagulation due to the high risk of severe bleeding. Compression therapy may help with managing symptoms of DVT but does not address the risk of PE. Administering INR screening is not relevant in this context, as it pertains to monitoring anticoagulation therapy rather than providing an alternative treatment for patients who cannot be anticoagulated. Thus, placing an IVC filter is the most appropriate management option in this scenario.