Randomized comparison of unfractionated heparin with corticosteroids in severe active inflammatory bowel disease

Abstract

Background: Heparin therapy may be effective in steroid resistant inflammatory bowel disease. Aim: A randomized pilot study, to compare unfractionated heparin as a first‐line therapy with corticosteroids in colonic inflammatory bowel disease. Methods: Twenty patients with severe inflammatory bowel disease (ulcerative colitis, n=17; Crohn’s colitis, n=3) were randomized to either intravenous heparin for 5 days, followed by subcutaneous heparin for 5 weeks (n=8), or high‐dose intravenous hydrocortisone for 5 days followed by oral prednisolone 40 mg daily, reducing by 5 mg per day each week (n=12). After 5 days, non‐responders in each treatment group were commenced on combination therapy. Response to therapy was monitored by: clinical disease activity (ulcerative colitis: Truelove and Witt Index; Crohn’s colitis: Harvey and Bradshaw Index), stool frequency, serum C‐reactive protein and α1 acid glycoprotein, endoscopic and histopathological grading. Results: The response rates were similar in both treatment groups: clinical activity index (heparin vs. steroid; 75% vs. 67%; P=0.23), stool frequency (75% vs. 67%; P=0.61), endoscopic (75% vs. 67%; P=0.4) and histopathological grading (63% vs. 50%; P=0.67). Both treatments were well‐tolerated with no serious adverse events. Conclusion: Heparin as a first line therapy is as effective as corticosteroids in the treatment of colonic inflammatory bowel disease. Large multicentre randomized comparative studies are required to determine the role of heparin in the management of inflammatory bowel disease.

Hospitalized ulcerative colitis patients have an elevated risk of thromboembolic events

“…In one study of patients with UC, all of whom had rectal bleeding, three of the 12 patients receiving full anticoagulation with heparin developed increased rectal bleeding, one requiring an urgent operation [20] . In the other study, of eight patients with IBD who received a continuous infusion of unfractionated heparin, no major bleeding events occurred [21] . Other trials have examined treatment with low molecular weight heparin.…”

Key role of mast cells and their major secretory products in inflammatory bowel disease

“…Similarly, Evans et al found that heparin was effective in treating corticosteroid-resistant ulcerative colitis [120] , and Yoshikane et al reported that heparin was very effective in the treatment of disseminated intravascular coagulation (DIC) caused by ulcerative colitis [121] . Recently, heparin was even suggested as a first line therapy in the treatment of severe colonic inflammatory bowel disease [122] , but should be administered in hospitalized patients only because of the risk of possible serious bleeding [123] . To overcome bleeding side effect, low molecular weight heparin (LMWH) was employed as adjuvant therapy [124] , and the patients showed good clinical and laboratory response with no severe adverse effects [125,126] .…”

Unfractionated or low molecular weight heparin for induction of remission in ulcerative colitis: A cochrane inflammatory bowel disease and functional bowel disorders systematic review of randomized trials

“…Three randomized, blinded studies published as abstracts only were excluded after attempts to contact the authors for further details about methodology and results were not successful. [22][23][24] Ang et al 25 enrolled patients with UC and Crohn's disease. This study was excluded because separate results were not provided for patients with UC.…”