If thrombolytic therapy is not used and hypotension persists or becomes more marked, or clinical features of shock or myocardial damage develop or worsen, thrombolytic therapy may then be used. PE Without Hypotension: Consistent with AT9, we recommend that most patients with acute PE who do not have hypotension are not treated with thrombolytic therapy. However, patients with PE without hypotension include a broad spectrum of presentations. At the mild end of the spectrum are those who have minimal symptoms and minimal cardiopulmonary impairment. As noted in the section Setting for initial anticoagulation for PE, many of these patients can be treated entirely at home or can be discharged after a brief admission. At the severe end of the spectrum are those with severe symptoms and more marked cardiopulmonary impairment (even though systolic BP is >90 mm Hg). In addition to clinical features of cardiopulmonary impairment (eg, heart rate, BP, respiratory rate, jugular venous pressure, tissue hypoperfusion, pulse oximetry), they may have evidence of right ventricular dysfunction on their CT pulmonary angiogram or on echocardiography, or evidence of myocardial damage as re ected by increases in cardiac biomarkers (eg, troponins, brain natriuretic peptide). TABLE 18 ] Summary of Findings: Systemic Thrombolytic Therapy vs Anticoagulation Alone for Acute PE Outcomes No. 