Background: Metal exposures may contribute to coagulation disorder, but it is lacking studies evaluating the associations between metals exposures and coagulation factors.
Objectives: To explore the associations of multiple plasma metals with coagulation factors X (FX) and XI (FXI) levels among Chinese in a cross-section study.
Methods: We measured plasma concentrations of 23 metals by inductively coupled plasma mass spectrometry, and detected plasma FX and FXI levels by enzyme-linked immunosorbent assay in 787 Chinese middle-aged and elderly. Generalized linear model was used to estimate beta (β) and 95% confidence interval (CI) for multiple plasma metals concentrations associated with FX and FXI levels. Principal component analysis was applied to extract principal components of metals related to FX and FXI levels.
Results: After multivariable adjustment in generalized linear models, β values of FXI levels in the highest quartiles to the lowest were 0.852 (95% CI: 0.240, 0.745; P for trend < 0.001) and 0.518 (95% CI: 0.233, 0.728; P for trend < 0.001) for copper and thallium, respectively. Restricted cubic spline analyses also revealed linear relationships for copper and thallium with FXI levels. As for FX levels, restricted cubic spline analyses also observed similar relationships of FX with copper and thallium, but without significant results in generalized linear models. Moreover, the first principle component, including copper, rubidium, selenium, titanium, and zinc, was associated with FX and FXI levels, with the trend significance (P for trend =0.001, and < 0.001, respectively).
Conclusions: Plasma copper and thallium were associated with FXI but not FX levels. Simultaneous exposure of multiple metals including copper, rubidium, selenium, titanium, and zinc, were associated with FX and FXI levels.

Copper; Thallium; Coagulation factor X; Coagulation factor XI; Principle component analysis; Cross-section study