Major in-hospital bleeding in patients with pulmonary embolism treated with systemic thrombolysis

Systemic thrombolysis is a therapeutic modality used in patients with acute pulmonary embolism (PE) presenting with hemodynamic instability. Although the administration of systemic thrombolysis is recommended in patients with high-risk PE, it should also be considered in intermediate-high-risk patients with clinical signs of decompensation (1). In patients with high-risk PE who have contraindications to systemic thrombolysis or already had non-successful systemic thrombolysis, catheter-directed or surgical reperfusion options should be considered (1). However, contraindications to systemic thrombolysis in the specific clinical setting of acute PE have mostly been extrapolated to PE from other indications such as stroke or myocardial infarction, or proposed on the basis of expert opinion.