How does enoxaparin cause hyperkalemia

Sample size was determined by power analysis with power of 0. Correlation of potassium with continuous variables was done using Pearson's r coefficient. For the analysis of potential risk factors for hyperkalemia, continuous variables were dichotomized. Known risk factors from the literature were included in a multiple logistic regression model to analyze the independent association of these risk factors with a higher risk of the development of hyperkalemia.

The median was used to dichotomize the continuous variables. In our study, we had 41 males and 19 females, and they were age matched [ Table 1 ]. Subcutaneous heparin and LMWH are commonly used in the treatment of angina, myocardial infarction, cortical venous thrombosis, and deep vein thrombosis [ Table 2 ]. Neither of the drugs increased serum potassium levels significantly after 5 days of therapy [ Table 3 ]. These findings prove the role of heparin and LMWH in inhibiting the aldosterone physiology thereby leading to increase in serum potassium levels and natriuresis.

On the basis of univariate analysis, patients who received heparin developed hyperkalemia which was significant. Multivariate-adjusted ORs in the logistic regression model were There were no significant correlations between increase in potassium levels with age, diabetic status, and blood urea in the two groups.

Effect of heparin on adrenal metabolism has been documented since s. These side effects are more common in elderly, renal insufficiency and diabetic patients. This could possibly be because of the heterogeneity of the populations studied and the regimens of heparin used.

Our findings confirm the role of renal insufficiency measured as CrCl in development of hyperkalemia. We found a marginally significant correlation between the development of hyperkalemia and basal potassium level, and similar findings have been reported by Gonzalez-Martin et al. The other risk factor identified was diabetes,[ 10 , 11 ] which is not seen in this study. Our results concur with those of Monreal et al. The practical implications of these findings are that routine monitoring of serum potassium concentration may be necessary.

Although aldosterone suppression is reported to occur within a few days of heparin treatment, the time needed to develop hyperkalemia may be extremely variable among patients, depending on their clinical background. This observation underlines the potential risk associated with an unmonitored treatment for a period longer than that used in our study.

But longer duration of heparin administration for chronic conditions needs careful monitoring. None of the patients had clinically relevant consequences. In conclusion, the short-term treatment with LMWH induces a significant increase in serum potassium level, but the related risk of clinically relevant hyperkalemia remains low. The limitations of the study are that the confidence interval of various parameters in univariate and multivariate analysis is wide i.

So a large sample size more than 30 will actually predict the risk of hyperkalemia. A further study with larger sample size has to be undertaken. Serum creatinine is not a risk factor in multivariate analysis because some other factor is masking its effects in predicting Hyperkalemia. Hence CrCl is a better marker in establishing hyperkalemia. LMWH-induced aldosterone suppression leading to hyperkalemia and hyponatremia natriuresis is more than heparin.

This adverse effect needs to be better anticipated by clinicians. Serum potassium should be monitored periodically in patients on heparin or LMWH for five or more days, especially in high-risk patients for hyperkalemia. Pathophysiology of Hypertension.

Hurst's The Heart, 13e. Accessed December, Heparin-induced aldosterone suppression and hyperkalemia. Am J Med ; Heparin-induced hyperkalemia: a prospective study. Early onset of hyperkalemia in patients treated with low molecular weight heparin: a prospective study.

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There are many different insulin preparations and supplies available in order to create individualized regimens for patients. Here are s Results Citations. Figures and Topics from this paper. Citation Type. Has PDF. Publication Type. More Filters. Drug-Induced Hyperkalemia. View 1 excerpt, cites background. Profound hyperkalemia associated with thromboprophylactic enoxaparin. Hyperkalemia in an intravenous catheter direct thrombolysis patient : a case report.

Heparin may cause hyperkalemia by blocking aldosterone biosynthesis in the adrenal gland.