Treatment of corticosteroid-resistant ulcerative colitis with heparin--a report of 16 cases.
BACKGROUND
Heparin, a group of sulphated glycosaminoglycans, in addition to its anticoagulant activity, has a wide range of potentially anti-inflammatory effects. These include inhibition of neutrophil elastase and inactivation of chemokines. Previous reports of fortuitous improvement in ulcerative colitis patients treated with heparin for prophylaxis of venous thrombosis, prompted us to perform a pilot study in patients with corticosteroid-resistant ulcerative colitis.


METHODS
Sixteen hospitalized patients in relapse from ulcerative colitis and unresponsive to high-dose corticosteroid therapy were treated with intravenous standard heparin (subcutaneous in two patients), the dose was adjusted to provide standard anticoagulant activity. Five patients continued with subcutaneous injections on discharge, with a gradual reduction in the frequency of doses.


RESULTS
Within 1 week of starting heparin, 12/16 patients had shown a considerable reduction in stool frequency. After 2 weeks of heparin therapy median stool frequency had improved from 8.0/day (range 6.3-10.0) pre-treatment to 3.5/day (2.5-5.25) (P = 0.008), and by 4 weeks 12/16 achieved clinical remission, Four patients required elective colectomy. Three patients were treated with heparin on a second occasion during a relapse, two failed to respond and required subsequent colectomy. Nine remain well. No serious complications were seen due to the anticoagulant activity, apart from bruising at subcutaneous injection sites.


CONCLUSIONS
The response to heparin in patients with ulcerative colitis resistant to standard therapy is encouraging and supports the previous uncontrolled evidence for a therapeutic effect. A controlled trial of heparin in ulcerative colitis is clearly indicated.
Evans
R C
RC
Department of Medicine, University of Liverpool, UK.
Wong
V S
VS
Morris
A I
AI
Rhodes
J M
JM
D000305:Adrenal Cortex Hormones / Q000494:pharmacology*; D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D003093:Colitis, Ulcerative / Q000188:drug therapy*; D004351:Drug Resistance; D005260:Female; D006493:Heparin / Q000627:therapeutic use*; D006760:Hospitalization; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects
D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D006493:Heparin