The impact of catheter-related thrombosis on femoral venous catheter removal in poisoned patients receiving temporary extracorporeal treatments: A retrospective study

This retrospective study aimed to systematically evaluate the impact of catheter-related thrombosis (CRT) on the safety, timing, and clinical decision-making for femoral venous catheter removal in poisoned patients undergoing short-term extracorporeal treatments. This study characterized the incidence of CRT associated demographic, laboratory, and clinical factors, thrombosis-related complications, and the role of anticoagulation therapy in management, with the goal of establishing evidence-based guidelines for optimizing catheter removal strategies in this population. Seventy-one poisoned patients with femoral venous catheters for extracorporeal treatments were retrospectively classified into CRT and non-CRT groups based on femoral venous ultrasound findings. Group differences in thrombosis incidence, baseline demographics, laboratory parameters (fibrinogen, D-dimer), clinical characteristics, thromboembolic complications, and anticoagulation effects were evaluated to inform evidence-based catheter removal practices. CRT occurred in 38% of patients that received a duplex ultrasound. Local insertion-site symptoms (51.9% vs 9.1%, P < .001) and progressive deep vein thrombosis (11.1% vs 0%, P = .051) were more common in the thrombosis group, while no pulmonary embolism or major bleeding occurred in either group. Those with thrombosis had significantly higher fibrinogen (3.23 vs 2.79 g/L, P = .019) and D-dimer (1.16 vs 0.36 mg/L, P < .001) concentration, along with a higher D-dimer positivity rate (74.1% vs 27.3%, P < .001). Multivariate analysis identified positive D-dimer (adjusted odds ratio = 7.83, P = .002) and local symptoms (adjusted odds ratio = 10.90, P = .002) as independent predictors. Post-removal ultrasound showed complete recanalization in 81.5% of thrombosis patients, with thrombus progression in 3.7%; anticoagulation duration correlated with partial recanalization (thrombus reduction or stability) in 14.8% of cases. In this small cohort of poisoned patients with short-term extracorporeal treatments, CRT dose not pose immediate life-threatening risks for femoral venous catheter removal, justifying safe and timely removal. Elevated fibrinogen, positive D-dimer, and local puncture-site symptoms indicate increased thrombosis risk. Prospective studies are needed to validate these findings and refine management strategies.