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 w eight heparin (LMWH) offers advantages in the method of administration but have not been evaluated in inflammatory bowel disease conditions. Aim: To assess the tolerabilty and safety of subcutaneous self-administered LMWH in outpatients with refractory ulcerative colitis and to evaluate any potential adjuvant therapeutic effect. Patients and Methods: Twelve patients with mild to moderately active ulcera tive 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 adminis tered twice daily for 12 weeks. Patients were monitored for possible advers e 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%) att ained complete remission after 12 weeks of treatment. Endoscopic, scintigra phic and histological scores were found to be significantly improved. Conclusion: Self-administered LMWH given s.c, may be a safe adjuvant therap y for patients with active, glucocorticosteroids-refractory ulcerative coli tis. A controlled trial should be undertaken to confirm the positive effect s found in this study.