The scientific statement revisits the Open Vein Hypothesis (OVH), which suggests that early clearance of venous thrombus and restoration of blood flow can help prevent postthrombotic syndrome (PTS) following deep vein thrombosis (DVT). PTS is a debilitating condition that affects up to 50% of patients after a DVT and significantly impairs quality of life. The authors note that despite anticoagulation and compression therapy, PTS remains prevalent, highlighting the need for improved prevention strategies. The paper emphasizes that sustained venous patency, minimized inflammation, and reduced recurrence are key to preventing PTS, especially in patients with iliofemoral DVT (IFDVT), who are at higher risk.

The review critically examines clinical trials investigating catheter-directed thrombolysis (CDT) and pharmacomechanical interventions, such as the CaVenT and ATTRACT trials. These trials yielded mixed outcomes, showing benefits in specific subgroups, particularly patients with IFDVT, but failing to demonstrate broad advantages in reducing PTS. The timing of intervention, thrombus chronicity, and patient-specific factors such as fibrinolytic capacity and inflammatory response appear to be critical determinants of efficacy. Additionally, the pathophysiology of PTS is discussed, focusing on the roles of venous hypertension, valvular reflux, inflammation, and fibrosis. These mechanisms reinforce the complexity of PTS development beyond just mechanical obstruction.

Furthermore, the study emphasizes the reversibility of AIC upon rhythm normalization and suggests that early identification through CMR can influence management and prognosis. Since AIC can mimic dilated cardiomyopathy, especially in patients presenting with heart failure symptoms and arrhythmia, distinguishing the two is crucial. This research contributes valuable insights by establishing a phenotype of AIC characterized by low fibrosis burden, preserved myocardial function, and good response to rhythm control.

Finally, the paper calls for a multidisciplinary, patient-centered care model for managing acute IFDVT, emphasizing the importance of early identification, risk stratification, personalized anticoagulation strategies, and long-term monitoring. The authors stress the need for equitable care delivery and further research into biological, clinical, and technological factors influencing PTS outcomes. They propose that refining the OVH with emerging science and integrating it into clinical practice could ultimately lead to more effective prevention and treatment of PTS.

The Open Vein Hypothesis suggests that early restoration of blood flow after deep vein thrombosis may reduce the risk of postthrombotic syndrome (PTS). Recent studies show mixed results, with benefits mostly seen in select high-risk patients like those with iliofemoral DVT. A multidisciplinary, personalized care approach and advanced imaging are key to improving PTS prevention and outcomes.

Source: https://www.ahajournals.org/doi/10.1161/CIR.0000000000001330