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December 8, 1997

Free-Floating Thrombus and Pulmonary Embolism-Reply

Author Affiliations

Boston, Mass

Arch Intern Med. 1997;157(22):2662. doi:10.1001/archinte.1997.00440430143019

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

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