Low molecular weight heparin as adjuvant therapy in active ulcerative colitis.
BACKGROUND
Heparin given intravenously has shown beneficial effects in the treatment of refractory ulcerative colitis in open trials. Low molecular weight heparin (LMWH) offers advantages in the method of administration but have not been evaluated in inflammatory bowel disease conditions.


OBJECTIVE
To assess the tolerability and safety of subcutaneous self-administered LMWH in outpatients with refractory ulcerative colitis and to evaluate any potential adjuvant therapeutic effect.


METHODS
Twelve patients with mild to moderately active ulcerative colitis were included in the trial. The patients had either responded poorly to treatment with conventional therapy, including oral and/or rectal glucocorticosteroids, or had experienced a rapid relapse during or shortly after GCS therapy. Dalteparin sodium 5000 units s.c. injection was administered twice daily for 12 weeks. Patients were monitored for possible adverse events and changes in clinical symptoms, and endoscopic and histological scores were analysed. Leucocyte scanning was performed at inclusion and at the end of the study.


RESULTS
Tolerability and compliance were excellent and no serious adverse events occurred. Eleven patients improved symptomatically and six (50%) attained complete remission after 12 weeks of treatment. Endoscopic, scintigraphic and histological scores were found to be significantly improved.


CONCLUSIONS
Self-administered LMWH given s.c. may be a safe adjuvant therapy for patients with active, glucocorticosteroids-refractory ulcerative colitis. A controlled trial should be undertaken to confirm the positive effects found in this study.
Törkvist
L
L
Department of Surgical and Medical Gastroenterology, Karolinska Institutet at Huddinge University Hospital, Sweden. leif.torkvist@karo.ki.se
Thorlacius
H
H
Sjöqvist
U
U
Bohman
L
L
Lapidus
A
A
Flood
L
L
Agren
B
B
Raud
J
J
Löfberg
R
R
D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D003093:Colitis, Ulcerative / Q000000981:diagnostic imaging / Q000188:drug therapy*; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects / Q000627:therapeutic use; D006495:Heparin, Low-Molecular-Weight / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D019690:Technetium Tc 99m Exametazime
D000925:Anticoagulants; D005938:Glucocorticoids; D006495:Heparin, Low-Molecular-Weight; D019275:Radiopharmaceuticals; D019690:Technetium Tc 99m Exametazime