My take on the conclusion: there is insufficient evidence to support the use of thrombolysis in intermediate-risk, nonmassive PE. If, however, your patient deteriorates into a haemodynamically unstable condition, then thrombolysis can be given then.
But, if you want to cherry pick data to build your argument...
- There may be a lower mortality rate with thrombolysis (on meta-analysis only, which has some significant methodological flaws and includes heterogeneous trials)
- There may be lower rates of long-term pulmonary hypertension (MOPETT, with a control rate of 57%)
- There doesn't seem to be an increase in significant bleeds in younger patients (meta-analysis)
- Maybe 1/2 dose thrombolysis works just as well and carries less risk (MOPETT)
On the other hand, the largest trial (PEITHO) found no improvement in mortality, but a significant increase in major bleeds, and concluded:
...great caution is warranted when considering fibrinolytic therapy for hemodynamically stable patients with pulmonary embolism, right ventricular dysfunction, and a positive cardiac troponin test.
I don't think we can argue with that.