Do you consider extensive clot burden as a factor in determining whether patients with submassive PE may be appropriate for thrombolytic therapy?

I don't either. I think it is fairly clear that mortality in PE correlates to hemodynamic effect and RV function, rather than clot burden (see Hariharan et al., PMID 27742425; Furlan et al., PMID 22993221), likely related to acute pulmonary hypertension caused by endogenous elaboration of such media...

I don't. Importantly we need to look at outcomes of thrombolysis irrespective of clot burden. Studies have shown that clot burden can be reduced with thrombolysis but so far RCTs have not shown that mortality can be improved by thrombolysis.

I agree with all the above comments, especially considering the risks of thrombolytics versus the benefits. I would favor suction thrombectomy for intermediate-high cases that are, or may decompensate for faster resolution of the obstruction versus CDT, but as noted that is based on resources availa...