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Perioperative changes in PIVKA-II.

Fredrik Dauti1, Magnus Hjaltalin Jonsson, Andreas Hillarp

  • 1a Blekingesjukhuset , Karlskrona , Sweden.

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Summary

Perioperative vitamin K absence for factor II (PIVKA-II) levels increase after surgery, even when routine coagulation tests remain normal. This suggests PIVKA-II may indicate early vitamin K deficiency in surgical patients.

Keywords:
PIVKA-IImalabsorptionprothrombin timesurgeryvitamin K

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Area of Science:

  • Biochemistry
  • Clinical Chemistry
  • Surgical Research

Background:

  • Proteins induced by vitamin K absence for factor II (PIVKA-II) is a marker for vitamin K deficiency.
  • PIVKA-II reflects uncarboxylated prothrombin and can detect vitamin K deficits before standard coagulation tests.
  • This study investigated perioperative changes in PIVKA-II levels.

Purpose of the Study:

  • To prospectively observe changes in PIVKA-II levels during the perioperative period.
  • To assess the utility of PIVKA-II as an early indicator of vitamin K status in surgical patients.
  • To compare PIVKA-II changes across different surgical types.

Main Methods:

  • Prospective observational study including patients undergoing abdominal or orthopaedic surgery.
  • Blood samples collected preoperatively and up to 5 days post-surgery.
  • Analysis of PIVKA-II, activated partial thromboplastin time, and prothrombin times (Quick and Owren).

Main Results:

  • Elevated preoperative PIVKA-II levels were observed in most patients.
  • PIVKA-II levels significantly increased by day 1 post-surgery and peaked by day 5.
  • Routine coagulation tests were predominantly normal, with no significant correlation to PIVKA-II.
  • Higher PIVKA-II increases were noted in patients undergoing anterior resection, emergency laparotomy, and emergency hip fractures.

Conclusions:

  • PIVKA-II levels rise in the perioperative period, independent of routine coagulation test results.
  • The findings suggest PIVKA-II's potential as a sensitive marker for perioperative vitamin K status.
  • Further research on vitamin K supplementation in patients with elevated PIVKA-II is warranted.