Precursor prothrombin status in patients receiving anticonvulsant drugs

Area of Science:

• Biochemistry
• Hematology
• Pharmacology

Background:

• Protein Induced by Vitamin K Absence (PIVKA) is a prothrombin precursor elevated when vitamin K-dependent carboxylation is impaired.
• Anticonvulsant drugs are commonly used in epilepsy treatment.
• Previous studies suggest a link between gestational anticonvulsant exposure and coagulation abnormalities.

Purpose of the Study:

• To assess PIVKA levels in adult epileptic patients undergoing anticonvulsant therapy.
• To determine if anticonvulsant use is associated with impaired blood coagulation in epileptics.
• To evaluate the potential need for vitamin K supplementation in this patient group.

Main Methods:

• PIVKA-positivity was measured in 16 adult epileptic patients on various anticonvulsants.
• PIVKA concentrations were compared to 10 age-matched healthy controls.
• Statistical analyses included t-tests and Fisher exact test.

Main Results:

• Epileptic patients had significantly higher mean PIVKA concentrations (4.6 +/- 2.3%) compared to controls (1.1 +/- 0.7%) (p < 0.001).
• 81% of epileptic patients exhibited PIVKA values above the control range (p < 0.001).
• No correlation was found between PIVKA levels and specific anticonvulsant medications; other coagulation indices remained normal.

Conclusions:

• Most adult epileptic patients on anticonvulsant therapy present with a subclinical coagulation defect.
• Elevated PIVKA levels in this cohort reinforce concerns about coagulation issues.
• Findings support the recommendation for antenatal vitamin K supplementation in pregnancies involving anticonvulsant therapy.