Massive PE is defined as a systolic blood pressure < 90 mm Hg or a drop in systolic arterial pressure of at least 40 mmHg for at least 15 minutes or hypotension that requires vasopressors or inotropic support and is not explained by other causes.
Exclude thrombolytic contraindications:
- Haemorrhagic stroke or stroke of unknown origin at any time
- Ischaemic stroke in the preceding 6 months
- Central nervous system damage or neoplasms
- Recent major trauma/surgery/head injury (in the preceding 3 weeks)
- Gastrointestinal bleeding within the last month
- Known bleeding risk.
-Transient ischaemic attack in the preceding 6 months
-Oral anticoagulant therapy
-Pregnancy or within 1 week postnatally
-Traumatic resuscitation (in relation to this episode of PE)
-Refractory hypertension (SBP >180 mmHg)
-Advanced liver disease
-Active peptic ulcer.