Low-dose low-molecular weight heparin (enoxaparin) is effective as adjuvant treatment in active ulcerative colitis - An open trial

Ulcerative colitis is a chronic inflammatory bowel disorder of unknown etio logy. Treatment of flare-ups is based on mesalamine and steroids. Treatment of moderate to severe ulcerative colitis with high-dose heparin and low-mo lecular-weight heparin was reported. The mechanism was assumed to be a comb ination of anti-coagulant and anti-inflammatory effects. Low-molecular-weig ht heparin is better and safer than unfractionated heparin. Studies of low- dose low-molecular-weight heparin in experimental models of inflammation an d in inflammatory diseases demonstrated a beneficial effect. Our aim in thi s study was to evaluate the effect of low-dose, low-molecular-weight hepari n in active ulcerative colitis. Twelve patients with flare-ups of colitis w ere prospectively enrolled. Subcutaneous injections of 5-mg enoxaparin were administered at weekly intervals for 12 weeks. Mesalamine doses remained u nchanged. Clinical, laboratory, endoscopic, histologic, and quality-of-life scores were evaluated at the beginning and end of the study. Ten patients completed the study. Mean age was 40.1; the female-mate ratio was 7:3. Mean Mayo scores were 9.0 +/- 0.94 at baseline and 3.4 +/- 2.0 at the end of th e study (P = 0.0001). Endoscopic scores decreased from 2.2 +/- 0.4 to 1.2 /- 1.0 (P = 0.049) and in 7 of 10 patients extent of disease shortened. A s ignificant increase in IBDQL scores from 135.7 +/- 37.17 to 179.6 +/- 45.15 points was demonstrated (P = 0.0117). Adverse events were one hospitalizat ion due to abdominal pain, arthralgia (1), transient peripheral edema (1). and elevation of alkaline phosphatase (1). During follow-up, one patient re quired colectomy and another experienced an exacerbation. In conclusion, lo w-dose low-molecular-weight heparin once a week, combined with mesalamine, may be an effective therapy for active ulcerative colitis. It may delay or preclude the need for steroid treatment. Controlled studies to evaluate eff icacy are needed.