TREATMENT OF CORTICOSTEROID-RESISTANT ULCERATIVE-COLITIS WITH HEPARIN- A REPORT OF 16 CASES

Background: Heparin, a group of sulphated glycosaminoglycans, in addit ion to its anticoagulant activity, has a wide range of potentially ant i-inflammatory effects. These include inhibition of neutrophil elastas e and inactivation of chemokines. Previous reports of fortuitous impro vement in ulcerative colitis patients treated with heparin for prophyl axis of venous thrombosis, prompted us to perform a pilot study in pat ients with corticosteroid-resistant ulcerative colitis. Methods: Sixte en hospitalized patients in relapse from ulcerative colitis and unresp onsive to high-dose corticosteroid therapy were treated with intraveno us standard heparin (subcutaneous in two patients), the dose was adjus ted to provide standard anticoagulant activity. Five patients continue d 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 f rom 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 patient s required elective colectomy. Three patients were treated with hepari n on a second occasion during a relapse, two failed to respond and req uired subsequent colectomy. Nine remain well. No serious complications were seen due to the anticoagulant activity, apart from bruising at s ubcutaneous injection sites. Conclusion: The response to heparin in pa tients with ulcerative colitis resistant to standard therapy is encour aging and supports the previous uncontrolled evidence for a therapeuti c effect. A controlled trial of heparin in ulcerative colitis is clear ly indicated.