Patients with CTEPH who are not candidates for pulmonary thromboendarterectomy may bene t from other mechanical and pharmacological interventions designed to lower pulmonary arterial pressure. Thrombolytic Therapy in Patients With Upper Extremity DVT Summary of the Evidence The AT9 recommendation was based on: (1) mostly retrospective observational studies suggesting that thrombolysis could improve short- and long-term venous patency, but a lack of data about whether thrombolysis reduced PTS of the arm; (2) occasional reports of bleeding in patients with UEDVT who were treated with thrombolysis, and clear evidence that thrombolysis increases bleeding in other settings; and (3) recognition that, compared to anticoagulation alone, thrombolytic therapy is complex and costly.1,167,168 We suggest that thrombolysis is most likely to be of bene t in patients who meet the following criteria: severe symptoms; thrombus involving most of the subclavian vein and the axillary vein; symptoms for <14 days; good functional status; life expectancy of $1 year; and low risk for bleeding. We also suggested CDT over systemic thrombolysis to reduce the dose of thrombolytic drug and the risk of bleeding. There is new moderate quality evidence that CDT can reduce PTS of the leg90 (Table 14, e-Table 15) and that systemic thrombolysis increases bleeding in patients with acute PE,143,147 and low-quality evidence that CDT can accelerate breakdown of acute PE.154 This evidence has indirect bearing on thrombolysis in patients with UEDVT, but it has not changed the overall quality of the evidence or our recommendations for use of thrombolysis in these patients. 27. In patients with acute upper extremity DVT (UEDVT) that involves the axillary or more proximal veins, we suggest anticoagulant therapy alone over thrombolysis (Grade 2C). 