Inclusion Criteria:  PE confirmed by computed tomography pulmonary angiography. PE symptoms duration ≤ 14 days.  High-risk PE with hemodynamic instability (one of):  cardiac arrest obstructive shock persistent hypotension. Intermediate-high risk PE patients with right ventricle dysfunction confirmed by imaging studies and elevated troponin level.  Exclusion Criteria:  1. Refusal to sign the informed consent form.