Sidlenafil in Combination With Oral Anticoagulants in Patients With Intermediate-high Risk of Pulmonary Embolism

Inclusion Criteria: * pulmonary embolism confirmed by CT scan with contrast, with localization of thrombusa in at least one main or proximal lobar pulmonary artery. * Right-left ventricular ratio (RV / LV) ≥1 derived from the apical four-chamber view * Who gave written informed consent to participate in research Exclusion Criteria: * Age \<18 or \>80 years * Symptoms of pulmonary embolism\> 14 days * Inadequate echocardiographic image quality in the apical four-chamber projection, which limits the measurement of RV / LV ratio * A significant risk of bleeding * The administration of thrombolytic drugs within the previous 4 days * Active bleeding * Known coagulopathy * Thrombocytopenia \<100,10\^9 / l * Previous use of vitamin K antagonists with an INR\> 2.5 at admission * History of any intracranial or spinal surgery or trauma or intracranial / spinal bleeding * Intracranial neoplasm * Arteriovenous malformations or aneurysms * GIH \<3 months * Cataract Surgery * Obstetrical manipulation * Cardiopulmonary resuscitation needed. * Other invasive procedures \<10 days * Allergy, hypersensitivity, thrombocytopenia to heparin or tissue plasminogen activator * Allergy to iodine contrast * A well-known right-left cardiac shunt, for example, a large patent foramen ovale, or atrial septal defect; large (\> 10 mm), or a blood clot in right atrium/right ventricle * Systolic blood pressure \<90 mm Hg for at least 15 minutes, or fall of systolic blood pressure is not less than 40 mm Hg for at least 15 min., with evidence of organ hypoperfusion (cold extremities or low diuresis \<30 mL / h, or confusion), or the need for administration of catecholamines to maintain adequate perfusion of organs and systolic blood pressure\> 90 mm Hg * Severe hypertension (systolic\> 180 mm Hg or diastolic\> 105 mm Hg.). * Pregnancy, lactation, delivery\<30 days * Participation in any other study (drug or device) * Life expectancy \<90 days * Refusal to participate in the study