Tissue plasminogen activator has a notoriously checkered past within emergency medicine, and its controversial use continues with the advent of targeted therapy for pulmonary embolism. Catheter-directed administration of tPA for PE is gaining traction, and the development of multidisciplinary PE Response Teams are popularizing and advocating this therapy. The evidence for this treatment strategy, however, raises concerns about its early adoption. Catheter-directed therapy (CDT) for PE involves placing a special catheter directly into the pulmonary artery, into or adjacent to the clot, followed by a continuous infusion of tPA. The thought is that by infusing the tPA directly into the pulmonary circulation, significantly lower doses can be used to achieve thrombolysis and to mitigate the risk of hemorrhage.

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