PARADOXICAL RESPONSE TO HEPARIN IN 10 PATIENTS WITH ULCERATIVE-COLITIS

Objectives: A patient with ulcerative colitis refractory to standard t herapy was treated with heparin for a deep vein thrombosis. Paradoxica lly, rectal bleeding did not increase; instead, his colitis rapidly we nt into remission. The same effect occurred when this patient was late r treated for a pulmonary embolism. On the basis of these observations and reports of a hypercoagulable state in ulcerative colitis, heparin was tested as a therapeutic agent in nine additional patients. Method s: Nine of the 10 patients had ulcerative colitis poorly controlled on sulfasalazine and prednisolone. Two had associated thromboembolic dis ease, and one was on no medication. Patients were started on heparin i n hospital, taught to self-inject subcutaneously, and discharged to co ntinue on 10,000 U of unfractionated heparin twice daily. Current dose s of sulfasalazine were maintained; prednisolone was tapered and stopp ed. Patients mere carefully monitored for adverse side-effects. Sectio ns of colonic mucosa from nine patients were examined for intravascula r thrombosis of the mucosal blood vessels. Results: Nine patients beca me asymptomatic (normal stool frequency, no rectal bleeding) on combin ed heparin and sulfasalazine therapy; one patient had a partial improv ement in symptoms. Highly significant statistical differences between pre- and posttreatment mean scores were found for all disease paramete rs. Intravascular fibrin thrombi were identified in sections from six of nine patients. No serious complications were associated with this u se of heparin. Conclusions: The heparin-linked remission of ulcerative colitis, observed by chance in our first patient, was followed by sim ilar responses in eight of nine further patients. This suggests that, used as described, heparin may have a role in treating refractory ulce rative colitis.