The relative value of thrombolysis and heparin for treatment of patients with pulmonary embolism is still a matter of debate. Agnelli et al performed a meta-analysis of studies comparing thrombolysis and heparin treatment in patients with pulmonary embolism with respect to the incidence of death, recurrence of pulmonary embolism, and major bleeding. The cumulative incidence of these adverse outcome events was similar in the 2 treatment groups. A risk reduction of 41% and 40% in favor of thrombolysis was observed for death and recurrence, respectively. When death and recurrence were analyzed together, a statistically significant risk reduction of 40% in favor of thrombolysis was observed. The rates of major bleeding were influenced by the thrombolytic regimens and by the use of invasive procedures, essentially pulmonary angiography. This was particularly the case for patients receiving thrombolytic treatment. The rate of intracranial bleeding in patients receiving thrombolysis for pulmonary embolism was 0.8%, similar to that reported in patients with myocardial infarction treated with thrombolysis. Findings from this meta-analysis showed that death and recurrences are reduced by thrombolysis with respect to heparin treatment. Excessive bleeding, which is mainly associated with invasive procedures, is the trade-off for the improved efficacy.