P306. Efficacy and safety of low-molecular weight heparin for the prevention of venous thromboembolism in patients with severe ulcerative colitis
A. Papa1, A. Armuzzi2, L. Guidi3, I. De Vitis4, G. Mocci5, C. Felice4, M. Marzo6, D. Pugliese1, G.L. Rapaccini7
1Catholic University of Rome, Internal Medicine and Gastroenterology Complesso Integrato Columbus, Rome, Italy; 2Complesso Integrato Columbus, Gastroenterology Unit, Rome, Italy; 3Università Cattolica Del Sacro Cuore, O.U. Gastroenterology Columbus, Rome, Italy; 4Università Cattolica Del Sacro Cuore, Complesso integrato Columbus/OU of Internal Medicine and Gastroenterology, Rome, Italy; 5Catholic University of Rome, Internal Medicine Gastroenterology, Rome, Italy; 6Complesso Integrato Columbus, Medicina Interna e Gastroenterologia, Rome, Italy; 7Catholic University of Rome, Complesso Integrato Columbus/OU of Internal Medicine and Gastroenterology, Rome, Italy
Background: Active ulcerative colitis (UC) is associated with an increased risk of venous thrombosis that occurs prevalently as deep vein thrombosis and pulmonary embolism. The prevention of venous thromboembolic events (VTE) in UC patients includes the use of low-molecular weight heparin (LMWH), particularly in hospitalized patients with severe disease. However, data on the safety and efficacy of LMWH for the prevention of VTE in patients with UC are limited, so we decided to perform a prospective open study to address these objectives.
Methods: All consecutive patients with severe UC admitted to our Department of Gastroenterology from January 2010 were included in this study. Enoxaparin (ENX), at a dose of 100 IU per Kg subcutaneously once a day, was added to standard therapy for all the time period considered at risk for VTE. During the study arterial oxygen saturation was controlled daily and the coagulation parameters including d‑dimer and blood counts monitored at least every 3 days. In case of clinical suspicion or laboratory findings suggestive of VTE the diagnostic tests required for the diagnosis of VTE were performed. The occurrence of new cases of VTE and side effects attributable to ENX, in particular an increase of rectal bleeding, was recorded. The obtained data were compared with those of a historical cohort of hospitalized UC patients with severe disease but not treated with ENX.
Results: Thirty patients were enrolled in the study, 15 in the group treated with ENX (group A) and 15 in the control group (group B). The average duration of treatment with ENX was 14±7 days. No patient in group A presented VTE during treatment, while four patients in group B developed thrombosis (p = 0.04). In group A two patients presented an increase of rectal bleeding compared to three patients in the control group (p = 0.5).
Conclusions: The results of the present study show that in a population of hospitalized UC patients with severe disease the use of ENX for the prevention of VTE is effective and safe. However, further studies on larger populations of patients are needed to confirm these findings.