Greenfield has a 2-decade experience in the treatment of patients suffering from venous thrombosis and PE. He has contributed greatly to the development of inferior vena caval filter, a treatment that has undoubtedly saved many lives. Nevertheless, concerning FFT, his arguments in favor of routine vena caval filtering, in opposition to the favorable results that my colleagues and I observed in 62 patients treated with anticoagulants alone,1 are somewhat contradictory.
Greenfield has underscored the value of a computerized patient database to assess the efficacy of a therapy. We have such a database in our institution, and since 1992, the charts of 639 patients with proximal deep venous trombosis have been recorded. Among these patients, 49.8% had FFT and 66% had a PE (57% being massive) on admission, but only 9% were treated initially with vena caval filtering. Anticoagulant therapy was administered in 98% of these 639 patients (with low-molecular-weight
Pacouret G. Free-Floating Thrombus and Pulmonary Embolism-Reply. Arch Intern Med. 1997;157(22):2662. doi:10.1001/archinte.1997.00440430143018