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Perioperative changes in PIVKA-II

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Author

Summary, in English

Background and aims. Proteins induced by vitamin K absence for factor II (PIVKA-II) is an enzyme-linked immunosorbent assay that monitors uncarboxylated prothrombin and responds to vitamin K deficits prior to changes in the prothrombin test. The aim of this project was to study perioperative PIVKA-II changes during various types of surgery in a prospective observational study. Methods. Patients undergoing abdominal or orthopaedic surgery were included. Blood was sampled on the day of surgery (preoperatively) and up to 5 days after surgery. The activated partial thromboplastin time, Quick and Owren prothrombin times were analyzed, together with PIVKA-II. Results. Thirty-nine patients were included, 27 male and 12 female. All but 7 patients had elevated PIVKA-II levels preoperatively. PIVKA-II levels had already increased significantly (p < 0.017) on day 1 after surgery as compared to presurgery plasma levels. The median PIVKA-II was highest on day 5. Routine tests were mostly normal. No significant difference in PIVKA-II was seen when comparing patients undergoing abdominal versus orthopaedic surgeries. There was no significant correlation between PIVKA-II and routine coagulation tests. Patients with anterior resection, emergency laparotomy and emergency hip fractures had higher postoperative increases, which could be linked to increased gastrointestinal recovery times, paralytic ileus, peritonitis and comorbidities. Conclusions. PIVKA-II levels increase during the perioperative period, despite mostly normal routine coagulation tests. Pre- and perioperative vitamin K supplementation in patients with elevated PIVKA-II levels should be studied, and its clinical significance be defined in future studies.

Publishing year

2015

Language

English

Pages

562-567

Publication/Series

Scandinavian Journal of Clinical & Laboratory Investigation

Volume

75

Issue

7

Document type

Journal article

Publisher

Informa Healthcare

Topic

  • Anesthesiology and Intensive Care
  • Surgery

Keywords

  • PIVKA-II
  • vitamin K
  • prothrombin time
  • malabsorption
  • surgery

Status

Published

Project

  • Koagulation vid kirurgi och kritisk sjukdom

Research group

  • Clinical Chemistry, Malmö

ISBN/ISSN/Other

  • ISSN: 1502-7686