Davies V A, Rothberg A D, Argent A C, Atkinson P M, Staub H, Pienaar N L
Lancet. 1985 Jan 19;1(8421):126-8. doi: 10.1016/s0140-6736(85)91901-4.
Protein induced by vitamin K absence (PIVKA) is the circulating prothrombin precursor found in considerable concentrations when carboxylation of prothrombin is impaired. In this study PIVKA-positivity was assessed in adult epileptic patients receiving a variety of anticonvulsant drugs. Mean PIVKA (+/- SD) concentration was 4.6 +/- 2.3% in 16 epileptics vs 1.1 +/- 0.7% in 10 age-matched controls (p less than 0.001). 13 of the 16 (81%) epileptics had PIVKA values above the highest value recorded for the controls (Fisher exact test, p less than 0.001). Other indices of coagulation were normal. There was no correlation between PIVKA concentration and the particular anticonvulsant taken. This study therefore shows that most epileptics on anticonvulsant therapy have a subclinical coagulation defect. These data, together with previous findings of raised PIVKA concentrations in maternal-infant pairs exposed to gestational anticonvulsants and reports of neonatal haemorrhage in infants of epileptics, strengthen the case for antenatal vitamin K supplementation in pregnancies complicated by anticonvulsant therapy.
维生素K缺乏诱导蛋白（PIVKA）是在凝血酶原羧化受损时以相当浓度存在于循环中的凝血酶原前体。在本研究中，对接受多种抗惊厥药物治疗的成年癫痫患者进行了PIVKA阳性评估。16例癫痫患者的平均PIVKA（±标准差）浓度为4.6±2.3%，而10例年龄匹配的对照组为1.1±0.7%（p<0.001）。16例癫痫患者中有13例（81%）的PIVKA值高于对照组记录的最高值（Fisher精确检验，p<0.001）。其他凝血指标正常。PIVKA浓度与所服用的特定抗惊厥药物之间没有相关性。因此，本研究表明，大多数接受抗惊厥治疗的癫痫患者存在亚临床凝血缺陷。这些数据，连同先前关于暴露于妊娠期抗惊厥药物的母婴对中PIVKA浓度升高的发现以及癫痫患者婴儿发生新生儿出血的报道，进一步证明了在合并抗惊厥治疗的妊娠中进行产前维生素K补充的必要性。
