The silent legacy of venous thromboembolism: why rehabilitation is the missing link

Venous thromboembolism (VTE), encompassing deep vein thrombosis (DVT) and pulmonary embolism (PE), remains a global health challenge. Modern advances in the management of acute VTE, such as the introduction of direct oral anticoagulants and interventional techniques, have led to a significantly decreased mortality rate, that however was simultaneously accounted for by a growing population of patients living with long-term disabling sequelae. The key complications are post-thrombotic syndrome (PTS) developing in 20–50 % of DVT patients that manifests as chronic venous insufficiency, edema, pain, and venous ulcers as well as chronic thromboembolic pulmonary hypertension (CTEPH), which occurs in up to 4.0 % of PE survivors and leads to progressive dyspnea, heart failure, and reduced exercise tolerance. The pathogenesis of these conditions is based on incomplete vein recanalization, valvular damage, persistent inflammation, and endothelial dysfunction in PTS, as well as thrombus organization and pulmonary vascular remodeling resulting in right heart failure in CTEPH. This article emphasizes the necessity to shift from an acute-event treatment model to a continuous chronic disease management paradigm. Effective rehabilitation requires a comprehensive multidisciplinary assessment, utilizing subjective scales and questionnaires alongside objective methods (duplex ultrasound, echocardiography, and cardiopulmonary exercise testing). Key components of a rehabilitation program include optimization of anticoagulation, nutritional support, compression therapy, early mobilization, and structured physical training to enhance the muscle-venous pump mechanism and cardiorespiratory fitness, as well as psychosocial support and lifestyle modification. VTE rehabilitation despite obvious demand faces a lack of standardized protocols, a scarcity of high-quality research, and unequal access to specialized care. Future directions include personalizing programs through risk stratification, utilizing telemedicine to improve treatment adherence, and developing clinical guidelines focused on long-term functional recovery and improved patients’ quality of life.