RT Journal
A1 Goldhaber SZ
T1 FRee-floating thrombus and pulmonary embolism-reply
JF Archives of Internal Medicine
JO Archives of Internal Medicine
YR 1997
FD December 8
VO 157
IS 22
SP 2662
OP 2662
DO 10.1001/archinte.1997.00440430143019
UL http://dx.doi.org/10.1001/archinte.1997.00440430143019
AB Greenfield is to be commended for his contributions to the management of venous thromboembolism during the past 3 decades. The Greenfield filter has saved the lives of many patients who could not tolerate anticoagulation or who suffered recurrent PE despite anticoagulation. Nevertheless, despite Greenfield's many achievements, one must question whether an FFT is a legitimate indication for routine filter insertion, especially since Pacouret and colleagues1 have successfully demonstrated that anticoagulation alone results in a recurrent PE rate of only 3% in this high-risk population.Five points are worth noting in response to Greenfield's letter. First, the insertion of vena caval filters has become increasingly common despite frequently "soft" indications. Second, even when the filter is successfully placed, without any complications, it may not prolong life or improve quality of life. Third, the filter does not neutralize an active thrombotic process; therefore, acute venous thrombosis will continue to propagate, unabated, in