Half dose TPA for massive and sub-massive PE

It may be just as good with less bleeding.

This is bound to cause controversy. According to an editorial in the same issue of Chest:

Physicians should consider using Wang and colleagues' reduced rt-PA dose regimen in lower body weight patients with PE with hemodynamic compromise or another indication for thrombolysis. As other peer-reviewed studies have reported, [14] , [15] efficacy failure might be addressed by re-treatment, with the same 50 mg or the approved 100-mg dose. Wang and colleagues' careful new look at rt-PA for thrombolysis is welcome. Although the results are not definitive, these data provide useful guidance that can favorably change practice.