No need for common practice of routinely supplementing potassium after heart surgery, say researchers

Medical Xpress / European Society of Cardiology / ESC Congress 2024 ^ | Sept. 2, 2024 | Professor Benjamin O'Brien et al

[ConservativeMind]

For the prevention of new-onset atrial fibrillation (AF) after isolated coronary artery bypass graft (CABG) surgery, giving potassium supplements only when levels dropped below the lower limit of normal was non-inferior to routinely supplementing potassium to the upper limit of normal, according to late-breaking research.

"AF occurs in around one in three patients after CABG. In many centers, patients are given potassium supplementation after surgery in an effort to maintain serum levels in the high-normal range ('tight control') to prevent AF. However, there is no robust evidence to support this practice.

TIGHT-K was an open-label, non-inferiority, randomized controlled trial.

Patients were randomized in a 1:1 ratio to a strategy of tight potassium control (potassium supplementation if serum levels fell below 4.5 mEq/L) or relaxed potassium control (potassium supplementation only if serum levels fell below 3.6 mEq/L).

The primary endpoint was the presence of new-onset AF after cardiac surgery (AFACS) in the 120 hours (5 days) after the operation, or up until discharge from hospital, whichever was sooner.

AFACS was defined as an episode of AF, flutter or tachyarrhythmia, of at least 30 seconds duration.

In total, 1,690 participants were randomized.

There was no significant difference in the primary endpoint, which occurred in 27.8% of patients in the relaxed control group and 26.2% in the tight control group.

The median (interquartile range) number of potassium administrations in the relaxed control group was 0 (0–5) compared with 7 (4–12) in the tight control group, and costs were four-fold higher with tight control.

"We were able to show that routinely supplementing potassium for tight control offers no benefits compared with relaxed control but is more expensive. Unnecessary intervention can carry risks, such as drug errors, and can negatively impact the patient experience, for example, the unpleasant taste of oral potassium supplements.

[ConservativeMind]

You don’t need the high potassium after a bypass.

[ConservativeMind]

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[BipolarBob]

Americans typically are potassium deficient. I’d be taking potassium supplements just in case. Remember, they want to keep on treating you, not cure you.

[Nateman]

Edema is what is being medicated for. Swelling of the legs and ankles. The medication given for that tends to deplete Potassium so Potassium is also prescribed.

[sauropod]

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