Clinical trial and registry data demonstrate that the ‘real world’ use of fibrinolytic agents in PE patients is associated with a high major bleeding and ICH risk. In the International Cooperative Pulmonary Embolism Registry (ICOPER),13 the rate of major bleeding was 21.7% and that of ICH 3.0%, while Fiumara et al.14 reported a 19.2% and 5.0% frequency, respectively. Previous studies have shown an association between bleeding complications and factors such as older age,15 female sex,16,17 high or low BMI,15 underlying malignancy, and several other co-morbid conditions.3,18 In our study, none of these factors significantly influenced the rate of major bleeding. This may have been because of the relatively small number of major bleeding events in this analysis.