In cases of intermediate-risk pulmonary embolism, what factors influence your decision to pursue catheter-directed thrombolysis?

"Intermediate-risk" is a complex term. Patients with intermediate-low risk are not prognostically the same as those with intermediate-high risk (i.e., with elevated cardiac biomarkers and RV dysfunction) (Santos et al., PMID 31017472), and my threshold to intervene on intermediate-high risk patients is much lower than it is for intermediate-low risk.

Focusing on catheter thrombolysis specifically, I think as our devices and skill with catheter-directed thrombectomy improves, the role for cathete...

Prognosis short and long term is excellent with heparin. This is supported by 40 years of data.

Would consider if anticoagulation contraindicated.

Unfortunately, I have seen such incredible morbidity and even death in patients with high central clot burden and echo abnormalities with stable vital signs. Death often occurs days after the initial presentation. With new catheter-based interventions and both the anecdotal responses and talk of eventual data becoming available, I wonder whether we should continue waiting…