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

Abstract

LMWH administered by extended colon-release tablets may be effective for the treatment of active UC. This benefit needs to be confirmed by further randomized controlled studies. The same benefits were not seen when LMWH was administered subcutaneously at lower doses. There is no evidence to support the use of UFH for the treatment of active UC.

The Role of Portal Vein Thrombosis in the Clinical Course of Inflammatory Bowel Diseases: Report on Three Cases and Review of the Literature

“…Among 182 case studies reported by Chande et al [38], patients with UC or CD comprised 4% of the total. …”

“…However, CT scan is more sensitive than US (which is more operator dependent and gives results that are less reproducible than those of CT) for detecting a thrombus within the splenic and mesenteric veins, and therefore it should be the preferred imaging technique for detecting both thrombi and pericolonic abscesses, especially in a setting of pylephlebitis [38]. A CT scan also provides a better assessment of bowel viability and the presence of a perforation, thus allowing one to work better in selecting patients for conservative management [39].…”

“…The use of anticoagulants in secondary prevention is recommended but can be limited by continued bleeding [41]. LMWH and devices such as inferior vena cava filters have been used with success, according to the literature [17, 38]. Both unfractionated heparin and LMWH have also been studied for induction of remission in UC without thromboembolic complications, but they have shown no benefit over standard therapies alone [42].…”

Protein losing enteropathy: comprehensive review of the mechanistic association with clinical and subclinical disease states

“…Subsequent studies have not supported this observation. Although there have been scattered reports of the effectiveness of heparin in the treatment of PLE in Crohn’s disease and ulcerative colitis,119,120 there have been many negative studies 121. Nevertheless, interest in this area was rekindled in 2008 by the report of Bode et al122 of a series of in vitro and in vivo mouse studies that clearly demonstrate the importance of heparin and heparan sulfate proteoglycan in modifying intestinal permeability.…”

Novel therapies for ulcerative colitis

“…In a Phase IIb trial, an MMX formulation of LMWH taken orally for 8 weeks has demonstrated its safety and superiority over placebo in inducing remission in mild-moderate left-sided colitis [1]. Because a prior trial of subcutaneous LMWH failed to demonstrate its efficacy over placebo [2], corroborating evidence for the promising results of the oral MMX compound are needed before affirming that oral colon-released formulations of LMWH are indeed efficacious in UC, unlike the subcutaneous administration route. Rosiglitazone is another agent tested in UC after benchside data suggested the role of reduced PPAR-g activity in mediating colonic inflammation.…”