Standard-dose Apixaban AFtEr Very Low-dose ThromboLYSis for Acute Intermediate-high Risk Acute Pulmonary Embolism

Inclusion Criteria: * Chest CT angiogram (CTA) evidence of proximal Pulmonary Embolism (PE) with a filling defect in at least one main pulmonary artery or lobar artery * PE symptom duration ≤14 days * Intermediate-high risk PE: defined as RV dysfunction with an RV/LV diameter ≥ 0.9, sPESI \> 0, and either troponin \> 0.05ng/mL or BNP \> 100 pg/mL, and hemodynamically stable (systolic blood pressure \> 90mmHg without the use of vasopressor support) * Randomization within 24 + 4 hours of anticoagulation * Signed and dated informed consent obtained from subject or legally authorized representative before initiation of any study procedures Exclusion Criteria: * Weight \> 130kg or \< 40 kg on day of randomization * Stroke or transient ischemic attack (TIA), head trauma, or other active intracranial or intraspinal disease within one year * Recent (within one month) or active bleeding from a major organ * Major surgery within 14 days * Clinician deems the subject too high-risk for bleeding using HAS-BLED criteria * History of any hematologic disease or coagulopathy * Cirrhosis (as determined by Child-Pugh B or C) * History of heparin-induced thrombocytopenia (HIT) * Hemodynamic instability defined as systolic blood pressure (SBP) less than 90mmHg and/or use of vasopressors for greater than 15 minutes * Severe hypertension as defined as SBP greater than 180mmHg * Cardiac arrest or active cardiopulmonary resuscitation (CPR) * Receiving neuraxial anesthesia or undergoing spinal punc…