title: Perioperative changes in PIVKA-II.
abstract: OBJECTIVE
  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.
authors.affiliation: a Blekingesjukhuset , Karlskrona , Sweden.
authors.forename: Fredrik
authors.initials: F
authors.lastname: Dauti
authors.forename: Magnus
authors.initials: M
authors.lastname: Hjaltalin Jonsson
authors.forename: Andreas
authors.initials: A
authors.lastname: Hillarp
authors.forename: Peter
authors.initials: P
authors.lastname: Bentzer
authors.forename: Ulf
authors.initials: U
authors.lastname: Schött
mesh_terms: D000005:Abdomen / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures; D059035:Perioperative Period; D011498:Protein Precursors / Q000097:blood*; D011516:Prothrombin
chemical_list: D015415:Biomarkers; D011498:Protein Precursors; C008208:acarboxyprothrombin; D011516:Prothrombin
keywords: PIVKA-II; malabsorption; prothrombin time; surgery; vitamin K