血红蛋白水平对食管癌患者术后辅助化疗联合利伐沙班抗凝治疗后深静脉血栓形成的影响OA

AIM To investigate the effect of hemoglobin(Hb)concentration on the development of lower extremity deep vein thrombosis(DVT)in esophageal cancer patients receiving postoperative adjuvant chemotherapy combined with rivaroxaban.METHODS A retrospective study was conducted on 112 patients with esophageal cancer admitted to our hospital from March 2021 to April 2024.Patients were stratified into 5 Hb quintiles(Q1-Q5).Correlations between Hb levels and postoperative DVT risk were analyzed,along with locally weighted scatter plot smoothing(LOWESS)regression for Hb levels and coagulation indicators.E-value sensitivity was evaluated.Restricted cubic spline(RCS)analysis was used to investigate the relationship between Hb levels and the formation of postoperative DVT in patients with esophageal cancer.Unconditional logistic regression models were used to assessed interactions between Hb levels and coagulation factors,with additive interactions calculated using Andersson's method.RESULTS Patients in different Hb quintiles differed significantly in male proportion,comorbidity rate,and levels of prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(FIB),and D-dimer(D-D)(P＜0.05).Multivariate logistic regression showed Hb levels remained independently associated with postoperative DVT risk in esophageal cancer patients after collinearity correction(P＜0.05),with higher Hb levels more strongly linked to DVT.Levels of Hb positively correlated with levels of PT,APTT,FIB,and D-D(all P＜0.01).RCS spline analysis revealed a nonlinear relationship between Hb level and postoperative DVT risk(P＜0.05).Threshold effect analysis indicated that in patients with Hb levels ≥ 124.77 g·L-1,the risk of postoperative DVT increased with rising Hb levels(P＜0.05).Multiplicative and additive interactions were observed between Hb level and coagulation parameters in relation to postoperative DVT formation.CONCLUSION In patients with esophageal cancer undergoing postoperative adjuvant chemotherapy combined with rivaroxaban anticoagulation,Hb levels demonstrated a nonlinear and independent association with the risk of DVT,with an inflection point identified at 124.77 g·L-1.Patients with moderate Hb levels exhibited a significantly reduced risk of DVT following anticoagulation.Hb can serve as an indicator for stratifying DVT risk,providing a basis for clinical individualized anticoagulation and precise thrombosis prevention.