A 54-year-old woman initially presented to her previous physician with swelling of the posterior aspect of the right lower leg and pain on ambulation. She was diagnosed with venous thromboembolism (VTE), probably secondary to external compression and a hypercoagulable state induced by a giant ovarian cancer. A temporary inferior vena cava (IVC) filter was placed to prevent pulmonary thromboembolism (PTE). Anticoagulation therapy was initiated with a continuous intravenous infusion of heparin for two days, which was subsequently changed to a direct oral anticoagulant (DOAC). The patient was then transferred to our institution for management of her ovarian cancer. Post-transfer computed tomography showed extensive thrombus within the IVC filter and bilateral lower extremities. DOAC therapy was discontinued and continuous intravenous heparin infusion was resumed. The patient underwent planned surgery for ovarian cancer, followed by the addition of tissue plasminogen activator (t-PA) and warfarin for post-operative thrombolysis. Despite these measures, the thrombus remained unchanged. Percutaneous retrieval of the IVC filter was attempted but was unsuccessful due to filter adherence and thrombus organization. Consequently, open surgical removal of the IVC filter with concomitant IVC ligation was performed. This case highlights the importance of appropriate anticoagulation to prevent thrombus-related filter adhesion and that surgical intervention may be beneficial when percutaneous retrieval is not feasible.