Protein Induced by Vitamin K Absence or antagonist-II (PIVKA-II) or des-gamma-carboxy prothrombin (DCP) is the precursor and abnormal form of prothrombin which was originally found in patients with hepatocellular carcinoma (HCC). PIVKA-II is thought to be produced as a consequence of an acquired defect of post-translational carboxylation of prothrombin’s precursor. In conjunction with alpha-fetoprotein (AFP), PIVKA-II is used to diagnose and manage HCC. Overall, assays detecting both PIVKA-II and AFP have shown a sensitivity and specificity of 94% and 98.5%, respectively.