In patients with low-risk PE and whose home circumstances are adequate, we suggest treatment at home or early discharge over standard discharge (eg, after the rst 5 days of treatment) (Grade 2B). Systemic Thrombolytic Therapy for PE Summary of the Evidence It has long been established that systemic thrombolytic therapy accelerates resolution of PE as evidenced by more rapid lowering of pulmonary artery pressure, increases in arterial oxygenation, and resolution of perfusion scan defects, and that this therapy increases The net mortality bene t of thrombolytic therapy in patients with acute PE, however, has been uncertain and depends on an individual patient s baseline (ie, without thrombolytic therapy) risk of dying from acute PE and risk of bleeding. Patients with the highest risk of dying from PE and the lowest risk of bleeding obtain the greatest net bene t from thrombolytic therapy. Patients with the lowest risk of dying from PE and the highest risk of bleeding obtain the least net bene t from thrombolytic therapy and are likely to be harmed. Evidence for the Use of Thrombolytic Therapy in Patients With Acute PE: AT9 recommendations for the use of thrombolytic therapy in acute PE were based on At that time, only about 800 patients with acute PE had been randomized to receive thrombolytic therapy or anticoagulant therapy alone and, consequently, estimates of ef cacy, safety, and overall mortality were very imprecise. In addition, the trials that enrolled these 800 patients had a high risk of bias and there was a strong suspicion that there was selective reporting of studies that favored thrombolytic therapy (ie, publication bias). Randomized trials have clearly established that thrombolytic therapy increases bleeding in patients with acute myocardial infarction,140 but that evidence was indirect when applied to patients with PE. 