PMID- 35658167 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20220823 IS - 1469-493X (Electronic) IS - 1361-6137 (Linking) VI - 8 IP - 8 DP - 2015 Aug 5 TI - Unfractionated or low-molecular weight heparin for induction of remission in ulcerative colitis. PG - CD006774 LID - 10.1002/14651858.CD006774.pub4 [doi] LID - CD006774 AB - BACKGROUND: There are a limited number of treatment options for patients with ulcerative colitis (UC). An increased risk of thrombosis in UC coupled with an observation that UC patients being treated with anticoagulant therapy for thrombotic events had an improvement in their bowel symptoms led to trials examining the use of unfractionated heparin (UFH) and low molecular weight heparins (LMWH) in patients with active UC. OBJECTIVES: To review randomized trials examining the efficacy of unfractionated heparin (UFH) or low molecular weight heparins (LMWH) for remission induction in patients with ulcerative colitis. SEARCH METHODS: We searched MEDLINE, EMBASE, CENTRAL, and the Cochrane IBD/FBD group specialized trials register up to June 2014. We also searched review papers on ulcerative colitis and references from identified papers in an effort to identify additional randomized trials studying UFH or LMWH use in patients with ulcerative colitis. We searched abstracts from major gastroenterological meetings to identify research published in abstract form. SELECTION CRITERIA: Randomized controlled trials comparing UFH or LMWH to placebo or a control therapy for induction of remission in ulcerative colitis were included. Studies published in abstract form only were included if the authors could be contacted for further information. DATA COLLECTION AND ANALYSIS: A data extraction form was developed and used to extract data from included studies. Two authors independently extracted data. Any disagreements were resolved by consensus. The Cochrane Risk of Bias tool was used to assess study quality. Data were analyzed on an intention-to-treat basis. The primary outcome was induction of remission, as defined by the studies. Secondary outcomes measures included: endoscopic remission as defined by the authors; clinical, histological or endoscopic improvement as defined by the authors; the occurrence of adverse events; the occurrence of bleeding; and improvements in quality of life as measured by a validated instrument. We calculated the risk ratio (RR) and corresponding 95% confidence interval for dichotomous outcomes. Data were combined for analysis if they assessed the same treatments (UFH or LMWH versus placebo or other therapy). The overall quality of the evidence supporting the outcomes was evaluated using the GRADE criteria. MAIN RESULTS: Five studies were eligible for inclusion (329 patients). Three studies (270 patients) compared low molecular weight heparin to placebo, one study (34 patients) compared LMWH in addition to standard therapy, and one study (25 patients) compared UFH to corticosteroids. The study comparing UFH to corticosteroids was rated at high risk of bias due to a single-blind design. The study that compared the addition of LMWH to standard therapy to standard therapy alone was rated at high risk of bias due to open-label design. The other three studies were rated as low risk of bias. LMWH administered subcutaneously showed no benefit over placebo for any outcome, including clinical remission (very low quality of evidence), and clinical, endoscopic, or histological improvement. High dose LMWH administered via an extended colon-release tablet demonstrated benefit over placebo for clinical remission (RR 1.39; 95% CI 1.09 to 1.77 ; P = 0.008; very low quality of evidence), clinical improvement (RR 1.28; 95% CI 1.06 to 1.55; P = 0.01; very low quality of evidence), and endoscopic improvement (RR 1.21; 95% CI 1.00 to 1.47 ; P = 0.05) but not endoscopic remission or histologic improvement. LMWH was not beneficial when added to standard therapy for clinical remission, clinical improvement, endoscopic remission or endoscopic improvement. LMWH was well-tolerated but provided no significant benefit for quality of life. One study examining UFH versus corticosteroids for the treatment of severe UC demonstrated the inferiority of UFH for clinical improvement. More patients assigned to UFH had rectal hemorrhage as an adverse event. AUTHORS' CONCLUSIONS: There is evidence to suggest that LMWH may be effective for the treatment of active UC. When administered by extended colon-release tablets, LMWH was more effective than placebo for treating outpatients with mild to moderate disease. 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. A further trial of UFH in patients with mild disease may also be justified. Any benefit found would need to be weighed against a possible increased risk of rectal bleeding in patients with active UC. CI - Copyright (c) 2015 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. FAU - Chande, Nilesh AU - Chande N AD - London Health Sciences Centre - Victoria Hospital, Room E6-321A, 800 Commissioners Road East, London, ON, Canada, N6A 5W9. FAU - Wang, Yongjun AU - Wang Y AD - Robarts Research Institute, Robarts Clinical Trials, P.O. Box 5015, 100 Perth Drive, London, ON, Canada. FAU - McDonald, John Wd AU - McDonald JW AD - Robarts Research Institute, Robarts Clinical Trials, P.O. Box 5015, 100 Perth Drive, London, ON, Canada. FAU - MacDonald, John K AU - MacDonald JK AD - Robarts Research Institute, Robarts Clinical Trials, P.O. Box 5015, 100 Perth Drive, London, ON, Canada. LA - eng PT - Journal Article PT - Review DEP - 20150805 PL - England TA - Cochrane Database Syst Rev JT - The Cochrane database of systematic reviews JID - 100909747 SB - IM UOF - doi: 10.1002/14651858.CD006774.pub3 PMC - PMC9392958 COIS- Nilesh Chande: Nilesh Chande has received fees for consultancy from Abbott , Ferring, and Actavis; fees for lectures from Abbott, travel expenses from Merck and has stock/stock options in Pfizer, Takeda, Glaxo Smith Kline, Proctor and Gamble and Johnson and Johnson. All of these financial activities are outside the submitted work. Yongjun Wang: None known John WD McDonald: None known John K MacDonald: None known EDAT- 2015/08/05 00:00 MHDA- 2015/08/05 00:01 PMCR- 2016/08/05 CRDT- 2022/06/05 01:01 PHST- 2022/06/05 01:01 [entrez] PHST- 2015/08/05 00:00 [pubmed] PHST- 2015/08/05 00:01 [medline] PHST- 2016/08/05 00:00 [pmc-release] AID - CD006774.pub4 [pii] AID - 10.1002/14651858.CD006774.pub4 [doi] PST - epublish SO - Cochrane Database Syst Rev. 2015 Aug 5;8(8):CD006774. doi: 10.1002/14651858.CD006774.pub4.