Do low-molecular-weight heparins influence the healing process in colon anastomosis?

Anastomosis leakage is one of the most serious complications of colorectal surgery. A role for extracellular matrix remodelling in the healing process of the colon wall has been recently postulated. Changes in matrix metalloproteinase (MMP) activity in the intestinal wall occurring prior to elective resection and primary anastomosis appear to be responsible for dehiscence leading to anastomosis. Thrombophylaxis using low-molecular-weight heparins is routinely administered to all patients during the perioperative period. However, adverse antiproliferative and proapoptotic effects such as limitation of bioavailability of growth factors and angiogenesis inhibition have been characterized in various cell types as a result of heparin administration. It is also likely that relationships exist between extracellular matrix homeostasis and the coagulation/fibrinolysis system. We hypothesize that subcutaneous administration of LMWHs (low-molecular-weight heparins) may influence matrix metalloproteinase activity in the colon wall and increase the risk of postoperative leakage.