The article by David Cundiff appeared in the "Comments, Opinions, and Brief Case Reports" section of the ARCHIVES. It presented his opinion, and thus a "counterbalancing editorial comment" would not have been appropriate.
His main point was that the only placebo-controlled randomized trial of heparin followed by oral anticoagulant therapy for acute pulmonary embolism was reported by Barritt and Jordan in 1960.1 Their study was underpowered and was "flawed" by current standards. The main evidence that anticoagulant therapy benefits patients with acute pulmonary embolism derives from comparing the mortality of untreated pulmonary embolism, approximately 30%,2 with the mortality of patients treated with heparin and oral anticoagulants, less than 5%.3 It is unlikely that further placebo-controlled randomized clinical trials will be performed.
Dalen JE. Does Anticoagulant Therapy Reduce Mortality of Acute Pulmonary Embolism?—Reply. Arch Intern Med. 2002;162(6):720. doi:
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