Anticoagulant drugs are basic therapy for all the patients in whom pulmonary thromboembolism (PTE) is highly suspected or diagnosed. It must be initiated as soon as PTE diagnosis is established and its duration of at least three months is recommended. In hemodynamically unstable patients, concomitant thrombolytic therapy is recommended for immediate lung reperfusion and to reduce mortality. Both anticoagulant and thrombolytic therapy carry an increased risk for bleeding, which increases morbidity, contributes to treatment modification and also could be fatal. Therefore, individual bleeding risk assessment is necessary during PTE management, and risk minimization strategies should be employed whenever possible. Few predictive models for bleeding were formed. In PTE population treated with thrombolysis, a two-leveled PEBSI score has been derived, but external validation is needed. During stable, long-term oral anticoagulant therapy, the VTE-BLEED score showed a high predictive value for bleeding event, even in the external PTE population. In order to minimize bleeding risk, new-generation drugs are recommended. Dose adjustment according to renal function and drug activity biomarkers is also necessary. It is still unclear whether a reduced dose of thrombolytics has a safer profile than full therapeutic doses. In PTE patients with a high risk for hemorrhage who need aggressive treatment, surgical thrombectomy or percutaneous interventions should be considered
