Unfractioned heparin in the therapy of patients with highly active inflammatory bowel disease

OBJECTIVE: Unfractioned heparin reportedly improves severe ulcerative colit is and Crohn's disease, but most of the few observations made have been pub lished as abstracts. This prospective study evaluated whether heparin resul ts in improvement of disease activity in patients with highly active, refra ctory ulcerative colitis or Crohn's disease. METHODS: Thirteen patients with ulcerative colitis and four patients with C rohn's disease received continuous intravenous heparin, aiming at a partial thromboplastin time of about 60 s for 2 wk. The following 6 wk, patients i njected 12,500 units of heparin twice daily. All patients received sulphasa lzine (1 g t.i.d.). Clinical and laboratory data were assessed weekly durin g the first month of treatment and every other week thereafter. RESULTS: A significant decline of clinical activity (p = 0.0059), C-reactiv e protein (p = 0.0119), and erythrocyte sedimentation rate (p = 0.0096) was observed in the ulcerative colitis patients. In Crohn's disease clinical a ctivity and laboratory values remained unchanged. Seven patients with ulcer ative colitis but none of the Crohn's disease patients achieved complete re mission after an average of 4 wk. In ulcerative colitis the histology (p = 0.0431) but not the endoscopic score (p = 0.1088) improved significantly. I n one patient with ulcerative colitis, massive colonic bleeding was observe d on day 11 of the study. CONCLUSIONS: These data are further evidence of a beneficial effect of unfr actioned heparin in the therapy of patients with highly active ulcerative c olitis. Because of possible serious bleeding, intravenous heparin should be administered in hospitalized patients only. (Am J Gastroenterol 1999;94:15 51-1555. (C) 1999 by Am. Coll. of Gastroenterology).