Comparison of heparin and steroids in the treatment of moderate and severe ulcerative colitis.
OBJECTIVE
Unfractionated heparin has been found to reduce symptoms and improve healing as adjuvant therapy in patients with ulcerative colitis. The current study evaluated the efficacy and safety of unfractionated heparin in the treatment of ulcerative colitis in comparison with methylprednisolone.


METHODS
A multicenter randomized trial with blinded endpoint evaluation was conducted in patients hospitalized for moderate or severe ulcerative colitis. Patients were randomized to receive heparin as a continuous infusion or methylprednisolone (0.75-1 mg x kg(-1) x day(-1)).


RESULTS
Twenty-five patients entered the study: 13 received methylprednisolone and 12 received heparin. By day 10, 69% of patients in the methylprednisolone group, but none in the heparin group, achieved significant improvement or remission. C-reactive protein levels significantly decreased in the methylprednisolone group but not in the heparin group. Three patients in the heparin group were withdrawn before day 10 because of an adverse event: rectal bleeding needing transfusion (2 cases) or surgery (1 case). The proportion of patients with persistent rectal bleeding at day 10 was 31% in the methylprednisolone group and 90% in the heparin group (P<0.05).


CONCLUSIONS
Unfractionated heparin as monotherapy is not effective in the treatment of moderate or severe ulcerative colitis and is associated with significant bleeding complications.
Panés
J
J
Gastroenterology Department, Institut Clinic de Malalties Digestives, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona. panes@medicina.ub.es
Esteve
M
M
Cabré
E
E
Hinojosa
J
J
Andreu
M
M
Sans
M
M
Fernandez-Bañares
F
F
Feu
F
F
Gassull
M A
MA
Piqué
J M
JM
D000328:Adult; D000893:Anti-Inflammatory Agents / Q000009:adverse effects / Q000627:therapeutic use; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D003093:Colitis, Ulcerative / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology; D006493:Heparin / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008775:Methylprednisolone / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D012002:Rectal Diseases / Q000453:epidemiology
D000893:Anti-Inflammatory Agents; D000925:Anticoagulants; D006493:Heparin; D008775:Methylprednisolone