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

• Published in: Digestive diseases and sciences Vol. 46; no. 10; pp. 2239 - 2244
• Main Authors: DOTAN, Iris, HALLAK, Aharon, ARBER, Nadir, SANTO, Moshe, ALEXANDROWITZ, Aharon, KNAANI, Yehudit, HERSHKOVIZ, Rami, BRAZOWSKI, Eli, HALPERN, Zamir
• Format: Journal Article
• Language: English
• Published: Heidelberg Springer 01.10.2001; Springer Nature B.V
• Subjects: Adult; Aged; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Anticoagulants - administration & dosage; Anticoagulants - therapeutic use; Biological and medical sciences; Blood. Blood coagulation. Reticuloendothelial system; Colitis, Ulcerative - drug therapy; Enoxaparin - administration & dosage; Enoxaparin - therapeutic use; Female; Humans; Male; Medical sciences; Mesalamine - therapeutic use; Middle Aged; Pharmacology. Drug treatments; Prospective Studies; Tropical medicine; Asia; Israel; Human; Low dose; Antiinflammatory agent; Adjuvant treatment; Low molecular weight heparin; Anticoagulant; Enoxaparin sodium; Inflammatory disease; Chemotherapy; Digestive diseases; Intestinal disease; Mechanism of action; Ulcerative colitis
• ISSN: 0163-2116; 1573-2568
• DOI: 10.1023/A:1011979418914

Ulcerative colitis is a chronic inflammatory bowel disorder of unknown etiology. Treatment of flare-ups is based on mesalamine and steroids. Treatment of moderate to severe ulcerative colitis with high-dose heparin and low-molecular-weight heparin was reported. The mechanism was assumed to be a combination of anti-coagulant and anti-inflammatory effects. Low-molecular-weight heparin is better and safer than unfractionated heparin. Studies of low-dose low-molecular-weight heparin in experimental models of inflammation and in inflammatory diseases demonstrated a beneficial effect. Our aim in this study was to evaluate the effect of low-dose, low-molecular-weight heparin in active ulcerative colitis. Twelve patients with flare-ups of colitis were prospectively enrolled. Subcutaneous injections of 5-mg enoxaparin were administered at weekly intervals for 12 weeks. Mesalamine doses remained unchanged. 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-male ratio was 7:3. Mean Mayo scores were 9.0 +/- 0.94 at baseline and 3.4 +/- 2.0 at the end of the 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 significant increase in IBDQL scores from 135.7 +/- 37.17 to 179.6 +/- 45.15 points was demonstrated (P = 0.0117). Adverse events were one hospitalization due to abdominal pain, arthralgia (1), transient peripheral edema (1), and elevation of alkaline phosphatase (1). During follow-up, one patient required colectomy and another experienced an exacerbation. In conclusion, low-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 efficacy are needed.