What is causing COVID-19 blood clots?

Michigan researchers have reported that they may have determined what causes blood clots in up to half of patients with severe COVID-19 infection. Specifically, the team assessed an autoimmune antibody that's circulating in the blood, attacking the cells and triggering clots in arteries, veins and microscopic vessels. "In patients with COVID-19, we continue to see a relentless, self-amplifying cycle of inflammation and clotting in the body," explained co-corresponding author Yogen Kanthi, an assistant professor at the Michigan Medicine Frankel Cardiovascular Center and a Lasker Investigator at the National Institutes of Health's National Heart, Lung, and Blood Institute. "Now we're learning that autoantibodies could be a culprit in this loop of clotting and inflammation that makes people who were already struggling even sicker." In the new Science Translational Medicine publication, they found about half of the patients who were very sick with COVID-19 were exhibiting a combination of high levels of both the dangerous antibodies and super-activated neutrophils. However, they added that these findings aren't yet ready for clinical practice; still, the findings add a new perspective to the robust thrombosis and inflammation research in patients with COVID-19. The researchers also are conducting a randomized clinical trial called DICER, which is testing dipyridamole in patients with COVID-19 to determine whether it's more effective than a placebo in reducing excessive blood clots. "Dipyridamole is an old drug that is safe, inexpensive, and scalable," Kanthi explained. "The FDA approved it 20 years ago to prevent clotting, but we only recently discovered its potential to block this specific type of inflammation that occurs in COVID."

Using machine learning to predict survival rates with OHCA

Combining neighborhood and local data with existing information sources creates a more accurate prediction on a patient’s recovery prospects after an out-of-hospital cardiac arrest (OHCA). That’s according to preliminary research slated for presentation at the American Heart Association’s Resuscitation Science Symposium 2020, which is taking place virtually between Nov. 14-16. Machine learning algorithms were developed and tested on almost 10,000 cases of OHCA that happened in Chicago’s 77 neighborhoods over a five-year period. Researchers used OHCA information from the existing Cardiac Arrest Registry to Enhance Survival (CARES) database to identify incidents that happened outside a health care system or a nursing home facility. They then added information about individual communities from the Chicago Health Atlas (CHA), including crime rates, access to health care and education. Researchers merged all of this information to train a machine learning model to predict OHCA survival. Adding the CHA data increased the average recall of OHCA survival predictions from 84.5% to about 87%. The study had limitations based on the quality of data, and more information that could affect the results such as weather, traffic, EMS routes and socioeconomic status need to be examined.

Remote cardiac rehabilitation proves itself

Preliminary research has shown that remote or virtual cardiovascular or cardiac rehabilitation programs using telecounseling were as effective as onsite programs offered in hospitals. The findings are slated for presentation at the American Heart Association's Scientific Sessions 2020, scheduled for Nov. 13-17. Two separate studies recently investigated the participation rates and effectiveness of remote, or virtual, rehabilitation programs for cardiac patients since the COVID-19 pandemic. One group in Canada launched a region-wide, community-based cardiovascular rehabilitation service in 2011. When the Canadian and provincial governments implemented a nationwide lockdown March 17 to limit the spread of COVID-19, the Central East Cardiac Rehabilitation Program rapidly transitioned from in-person, on-site to virtual content within one week. "We anticipated that the pandemic response would negatively impact referral, acceptance and completion rates," said Joseph Ricci, medical director of the Central East Cardiovascular Rehabilitation Program in Toronto, and lead author of this study. "Our centralized processes allowed uninterrupted referrals, and although office closures reduced community referrals, inpatient referrals increased." Further, patient acceptance and adherence were not significantly reduced vs. traditional cardiac rehabilitation services. With that said, a disadvantage of virtual cardiac rehab could be the higher cost in comparison to on-site delivery. In this study, the cost per patient was roughly doubled as a result of staff costs related to more frequent one-on-one patient consultation and smaller group interactions. In a separate study, the University of Tokyo Hospital established a remote cardiovascular rehabilitation program for patients with heart failure. Remote participants received telephone support from cardiologists and nurses specializing in heart failure every two weeks for five months after hospital discharge. Each got a DVD of the cardiac rehab program, used their own medical devices at home and tracked their daily steps using a mobile app. Results showed that remote cardiac rehabilitation is as effective as outpatient rehab for improvements in short-term prognosis after hospital discharge for patients hospitalized with heart failure. The emergency readmission rate within 30 days after discharge was lower in both the outpatient and remote groups vs. patients who did not receive any rehabilitation services. In addition, patients' quality of life scores one month after discharge were higher in the remote group than the patients in the outpatient group.