An extensive review of the literature found that
heparin (both unfractionated and low- molecular-weight heparins) and heparinoids inhibit the secretion of aldosterone, which can cause hyperkalaemia. This may be additive with the hyperkalaemic effects of angiotensin II
receptor antagonists.
The CSM in the UK suggests that potassium should be measured in all patients with risk factors (
renal impairment,
diabetes mellitus, pre-existing acidosis and those taking potassium-sparing drugs) before starting heparin, and monitored regularly thereafter (every 4 days has been suggested).