Inclusion Criteria:  Patients ≥18 years Confirmed acute pulmonary emboli by computed tomography pulmonary angiography (CTPA) Symptom onset ≤14 day Elevated N-terminal-proB-type natriuretic peptide and cardiac troponin Right ventricle/left ventricle ratio >0.9 in transthoracic echocardiography Less than 48 hours of anticoagulation therapy Willingness for participation in the study with signed and dated informed consent form  Exclusion Criteria:  Pulmonary emboli detected by modalities other than CTPA Segmental PE High risk (massive) Severe renal dysfunction(creatinine clearance [CrCl] below 30 mL/min) Terminal illness Surgery within 2 weeks Platelet count <50.000 /µL Pre and post catheter directed thrombolysis echocardiography exam not possible Contraindication to thrombolytic therapy Concomitant right heart thrombi Allergic reaction to study medications Lack or withdrawal of informed consent