TABLE 18 ] Summary of Findings: Systemic Thrombolytic Therapy vs Anticoagulation Alone for Acute PE Outcomes No. of Participants (Studies) Quality of the Evidence (GRADE) Relative Effect Anticipated Absolute Effects Risk with Anticoagulation Alone Risk Difference with Systemic Thrombolytic Therapy (95% CI) All-cause mortality Moderatea because of imprecision (from 5 fewer to 26 fewer) Recurrent PE 2,043 Moderatea because of imprecision (from 8 fewer to 24 fewer) Major bleeding 2,115 High (from 29 more to 87 more) Intracranial hemorrhage Moderatea because of imprecision (from 2 more to 21 more) The basis for the assumed risk (eg, the median control group risk across studies) is provided in the footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). See Table 1 and 4 legends for expansion of abbreviations and GRADE Working Group grades of evidence. a Low number of events. b Estimate from Chatterjee et al.147 Other estimates from meta-analyses on this topic include Dong et al:238 (intermediate-risk PE only): OR, 0.46 (intermediate-risk PE only): OR, 0.42 (0.17-1.03). c Majority (83%) of participants in Chatterjee et al147 were moderate risk. d Estimate from Chatterjee et al.147 Other estimates from meta-analyses on this topic include Dong et al:238 RR, 0.60 (0.21-1.69). e Estimate from Chatterjee et al.147 Other estimates from meta-analyses on this topic include Dong et al:238 : RR, 1.16 RR, 2.07 (0.58-7.35). f Estimate from Chatterjee et al.147 Bibliography: Chatterjee et al147 We suggest that patients without hypotension who are at the severe end of the spectrum be treated with aggressive anticoagulation and other supportive measures, and not with thrombolytic therapy. These patients need to be closely monitored to ensure that deteriorations are detected. 