OBJECTIVE: To evaluate the therapeutic efficacy of thrombolysis in patients with pulmonary embolism (PE) and pulmonary hypertension (PH), and identify factors influencing therapeutic outcomes. METHODS: A retrospective analysis was conducted on 148 patients diagnosed with PE complicated by PH who received thrombolytic treatment at Tianjin Medical University General Hospital and Inner Mongolia People's Hospital between January 2022 and August 2024. Changes in inflammatory markers, blood gas parameters, and coagulation function indicators before and after treatment were compared, and the overall treatment efficacy rate was calculated. Patients were stratified based on therapeutic response, and a binary logistic regression model was employed to analyze factors associated with treatment effectiveness. The predictive value of these factors was assessed using receiver operating characteristic (ROC) curve analysis. RESULTS: Within 24 hours post-thrombolysis, primary symptoms and clinical signs significantly improved. Specifically, respiratory rate (RR), heart rate (HR), and partial pressure of carbon dioxide (PaCO CONCLUSION: Thrombolytic therapy effectively improves clinical symptoms, physical signs, hemodynamic parameters, and cardiac function in patients with PE complicated by PH. Furthermore, in clinical practice, early monitoring of inflammatory markers such as PaCO