Can fibrinolysis improve outcomes in patients with intermediate-risk pulmonary embolism (PE)? The PEITHO trial investigated whether fibrinolysis could reduce mortality and complications in patients with intermediate-risk PE. This multicenter randomized controlled trial enrolled patients with intermediate-risk PE, characterized by right ventricular dysfunction and elevated biomarkers but without systemic hypotension. The study found that fibrinolysis significantly reduced the incidence of hemodynamic collapse and in-hospital mortality, but it also led to a higher rate of major bleeding. Despite the risks, the trial suggested that fibrinolysis may be beneficial in select intermediate-risk PE patients, prompting further debate about the optimal management of this patient group.