Low molecular weight heparin treatment in steroid refractory ulcerative colitis: Clinical outcome and influence on mucosal capillary thrombi

Background: In ulcerative colitis, a state of hypercoagulation bus frequent ly been observed. Unfractionated heparin has shown beneficial effects as an adjuvant treatment of steroid refractory ulcerative colitis in open trials and in one placebo-controlled trial. Low molecular weight heparin (LMWH) o ffers advantages in the method of administration, but it has not been evalu ated in severe ulcerative colitis. We therefore assessed the tolerability, safety and potential therapeutical effects of LMWH in hospitalized patients with steroid refractory ulcerative colitis. Methods: Twenty-five patients with severely active ulcerative colitis were included in an open-labelled t rial. All patients had a flare-up of disease under glucocorticosteroid trea tment. Nadroparine calcium 5.700 IE anti-Xa/0.6 mL s.c. was self-administer ed twice daily for 8 weeks. Patients were monitored for possible adverse ev ents. and changes in clinical symptoms and in laboratory. endoscopical and histological results were analysed. Results: Tolerability and compliance we re excellent and no serious adverse events occurred. In 20 of 25 patients, a good clinical and laboratory response was observed. Also, the endoscopic and histological signs of inflammation were found to be significantly impro ved. However, this was not accompanied by a significant reduction in the nu mber of mucosal microvascular thrombi after 8 weeks of LMWH treatment. Conc lusion: LMWH may be a safe adjuvant therapy for patients with active, gluco corticosteroid refractory ulcerative colitis.