Objective: To explore the relationship between anticoagulant Xa factor activity and serum endothelin-1 (ET-1), solute carrier family 39 member 11 (SLC39A11) and the occurrence of deep vein thrombosis (DVT) in the lower extremities of patients with gynecological malignancies Methods: A total of 270 patients with gynecological malignant tumors (malignant group) and 230 patients with gynecological benign tumors (benign group) who underwent surgical treatment in our hospital from October 2023 to October 2025 were selected as the research subjects. Determine the antixa factor activity and the levels of serum ET-1 and SLC39A1 Lasso-Logistic regression was used to analyze the influencing factors of lower extremity deep vein thrombosis (DVT) In addition, the predictive value and clinical significance of anti-Xa factor activity, serum ET- 1, and SLC39A11 levels in the occurrence of lower extremity DVT in patients with gynecological malignant tumors were analyzed. Results: Compared with the benign group, the malignant group had lower anti-factor Xa activity and higher levels of serum ET-1 and SLC39A11(P < 0.05). D-dimer, antithrombin Xa activity, serum ET-1, and SLC39A11 are the influencing factors for the occurrence of lower extremity DVT in patients. (P<0.05).The area under the curve (AUC) of anti-Xa factor activity, serum ET-1, SLC39A11 in predicting lower extremity deep vein thrombosis (DVT) in patients with gynecological malignancies were 0.844, 0.799, 0.771 and 0.931 respectively, all of which had good predictive value Within the risk threshold range of 0.06 to 0.83, the combined prediction of antifactor Xa activity, ET-1, and SLC39A11 for lower extremity DVT in patients with gynecological malignancies has a significantly greater net benefit than that of a single indicator Conclusion: The anti-Xa factor activity, ET-1, SLC39A11 are related to the occurrence of DVT in patients with gynecological malignant tumors. Combined with other factors, they have a good application prospect for predicting postoperative lower extremity DVT.