Background: Initial assessment of acute Pulmonary Embolism (PE) is essential in risk stratification into low-risk and high-risk (massive) Pulmonary embolism as per the hemodynamic stability. Patients with submassive PE who are likely to progress for hemodynamic instability should receive anticoagulation and should be monitored.

Method: This is a descriptive case report of a 45-year-old female who presented with history of nonproductive cough for 2 weeks, associated with retrosternal chest pain and shortness of breath. On physical exam her vitals were: temp 38.1 degrees Celsius, BP 160/106mmhg, SPO2 84% on room air, pulse 113b/min, R/R 26 cycles/min. She had distended neck veins with vigorous pulsation seen JVP 10mmhg. On auscultation there was reduced air entry and a systolic murmur in left sternal border, D dimer >6000ng/dl (0-500ng/dl), cardiac troponin 0.6ng/ml. Computerized tomography pulmonary angiogram (CTPA) revealed bilateral pulmonary emboli in the right and left pulmonary arteries and an echo suggestive of severe pulmonary arterial hypertension with a peak value of > 70mmhg with preserved left ventricular ejection fraction (LVEF) 57%.

Results: Successful thrombolysis was achieved with half dose Tenecteplase. There was no bleeding during and after Tenecteplase administration. The patient was discharged on the 4th day in stable condition.

Discussion: Half-dose thrombolysis with Tenecteplase has shown to improve pulmonary perfusion resulting in improved clinical symptoms and a short hospital stay with minimal 

chance for bleeding issues. Patients with sub massive PE at highest risk for progression to hemodynamic instability should receive anticoagulation and be monitored for clinical deterioration.

Conclusion: Low-dose Tenecteplase is therefore a safe and efficacious treatment option for sub massive PE as denoted. However, larger randomized controlled trials are needed to establish low-dose Tenecteplase as an accepted treatment modality.