Trial Duration: 24 months Start Date: October 2015 Stop Date: June 2017 Publication: 2017 Standard Therapy Anticoagulation is the main therapy for acute PE once the diagnosis is established. The main objectives of anticoagulant therapy in the initial treatment are to prevent thrombus extension and secondary recurrence of venous thromboembolism. Current guidelines recommend an initial treatment for at least 5 days with either subcutaneous low-molecular-weight heparin (LMWH), intravenous or subcutaneous unfractioned heparin, or subcutaneous fondaparinux as well as the initiation of oral vitamin-K antagonists at the same time. 6 In addition to anticoagulation, the recent European Society of Cardiology (ESC) guidelines recommend systemic thrombolysis in PE patients at high risk of death (Grade 1B) and should be considered in patients at intermediate-high risk of death.6 However, recent evidence shows that hemodynamic decompensation is prevented in patients with intermediate-high risk PE, but the incidence of major bleeding complications (20%) and intracranial hemorrhage (up to 3%) increased significantly.8 Therefore systemic fibrinolytic therapy is withheld in the majority of cases mainly due to the fear of life-threatening bleeding complications including intracranial hemorrhage. 4 Due to the high risk of intracranial bleeding complications, systemic thrombolysis therapy is no longer performed at the Inselspital Bern.