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—With respect to the letter from Dr Blebea and Ms Ewald, we appreciate that it may be "difficult to accept" our stated frequency of asymptomatic PE. However, we stand by our estimate, which (as we indicated) is a conservative one. We refer them, also, to prior studies validating our estimates in our article's references. Further, we would indicate that performing angiography in asymptomatic patients with proximal DVT was not in our protocol and may be problematic as an element of any prospective study.As to cost-effectiveness of V/Q scans, we also indicated that this issue needs to be addressed. Because we perform a perfusion scan first and, if it is normal, do not perform a ventilation scan, our costs are lower than quoted in their letter. Perhaps more importantly, costs of prolongation of hospitalization and considerations of filter insertions in cases of apparent "anticoagulant failure" are substantial.With
Moser KM, Fedullo PF. Asymptomatic Pulmonary Embolism Complicating Deep Venous Thrombosis-Reply. JAMA. 1994;272(7):517-518. doi:10.1001/jama.1994.03520070035028