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June 12, 1981

Pulmonary Thromboembolism — Update-Reply

JAMA. 1981;245(22):2295. doi:10.1001/jama.1981.03310470011005

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In Reply.—  This is to clarify the statement we made that anticoagulation "may be unnecessary in patients with minimal PTE who have unimpaired ventilation, no antecedent pulmonary parenchymal disease, a normal heart, and no peripheral venopathy." We were referring to women receiving anticonceptive pills in whom an episode of minimal, acute PTE may develop, to patients who have catheters, in which thrombi at the tip of the catheter have become dislodged and the patient has experienced acute chest pain from iatrogenic pulmonary thromboembolism, and to patients who have had transhepatic obliteration of gastroesophageal varices with autogenous blood clots, and some of the clots have migrated into the pulmonary circulation and also cause iatrogenic embolism. In such situations the risk of reembolization is negligible, and, consequently, anticoagulation should not be necessary. In fact, we agree that, in general, IV administration of heparin is recommended whenever pulmonary thromboembolism is suspected. However, as