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A Tech Approach to Predicting Blood Clots

LCM Alum, Dr. Yitzchak Goldstein, talks about his research.

December 20, 2013
Third-year pathology resident Yitzchak Goldstein, MD, is using analytical software to predict a patient's risk of developing a life-threatening blood clot.
Third-year pathology resident Yitzchak Goldstein, MD, is using analytical software to predict a patient's risk of developing a life-threatening blood clot.

 

Dr. Yitzchak Goldstein (whose formal name is actually Dr. Doctor Y. Goldstein – but more on this below!) is putting his love for science and technology into action at Montefiore Medical Center.

When he’s not busy on his Cytology rotation, the third-year pathology resident spends his time analyzing data mined from thousands of electronic records to determine whether certain laboratory tests can accurately predict a patient’s future risk of developing a life-threatening blood clot.

Using Clinical Looking Glass (CLG), a proprietary analytics software program developed by researchers and clinicians at Montefiore Medical Center, Dr. Goldstein is able to collect clinical and laboratory data on hospital patients to determine who has been tested for certain antibodies, which tests came back positive, which came back negative, and which patients developed a clot. 

In the past, this type of analysis required laborious and time consuming reviews of patient medical records – not to mention the not infrequent difficulties of deciphering handwritten physicians’ notes.  However, using CLG, thousands of patients who had a lab test performed can be followed over time with computer-assistance to see if - and when - they develop a clot.

“If we can identify those patients who are at high risk of developing a clot, we can say it’s someone for whom clinicians should consider medicating with anti-coagulants,” said Dr. Goldstein, 30, who is assisting Dr. Jacob Rand, a hematologist, and professor in the department of pathology at Einstein and director of the medical center’s Hematology Laboratories.

Dr. Rand’s research laboratory focuses on the investigation of the effects of antiphospholipid (aPL) antibodies on an anticoagulant protein, annexin A5 (previously known as annexin V). The antiphospholipid (aPL) syndrome is an enigmatic autoimmune disorder that is characterized by thrombosis and/or recurrent spontaneous pregnancy losses that occur in patients who have evidence for antibodies against phospholipid-binding proteins.  Deep vein thrombosis (DVT) and pulmonary embolism (PE) – clots in the legs and lungs – are often under-diagnosed and serious, but preventable medical conditions. 

The CDC estimates between 300,000 to 600,000 people are affected by blood clots, and every year between 60,000 and 100,000 die.

But predicting who is going to develop a clot and what laboratory tests can be used to determine the likelihood is no easy task.

Blood tests for APS look for at least one of three antibodies - anticardiolipin, beta-2 glycoprotein I and lupus anticoagulant, and the antibodies must appear in the blood at least twice to confirm the diagnosis. 

“Right now for a patient who has the antibodies, we wait to see if they develop a second clot. It’s difficult to tease out who should be on an anti-coagulant because there are risks associated with prescribing them, including bleeding and strokes,” Dr. Goldstein said.  “If you have a patient that we have identified as being at high risk, you can say it’s someone for whom a ‘blood thinner’ should be considered.”

To create a baseline, he collected records of all Accountable Care Organization (ACO) patients and followed them using CLG to see who developed a clot. He then compared the risk in those patients to patients who had tested positive for each of the antiphospholipid antibodies.

The results were striking.

One test, the lupus anticoagulant, showed a markedly elevated probability of developing a clot, whereas the other antibody tests seemed to show some risk but to a lesser degree than the lupus anticoagulant over the baseline.

“If we’re talking about which tests to start thinking about for a patient; if lupus anticoagulant comes back positive it’s already considered a high risk, and our data strengthens that point,” Dr. Goldstein said.

“We see that each of the antibodies has an increased risk of thrombosis over the baseline, but that not all antibodies are created equal in their ability to predict and prognosticate the development of a clot.”

By developing a scoring system, pathologists can see who is at high risk and treat patients accordingly.

The CLG program was created in 2002 by Montefiore clinicians and administrators driven to find information that could possibly control the rampant spread of tuberculosis and HIV among 15,000 inmates at Riker’s Island.

It has since been used in many programs at Montefiore and outside the medical center.  For example, CLG has helped identify the 58% of diabetics who were not being successfully controlled, leading to targeted outreach activities which reduced the percentage of uncontrolled diabetics by over one-third.

So far, Dr. Goldstein has amassed data from over 11,000 patients dating back to about 1996.  He says the information can help better target at-risk patients for treatment.

He recently presented his findings regarding the antiphospholipid antibodies using CLG at The American Society of Hematology's (ASH) Annual Meeting, in New Orleans.

A native New Yorker and Einstein graduate, his training at Montefiore as a pathology resident has brought his life full-circle.  After all, he was born in Weiler hospital, where his mother worked as an OR nurse for 33 years. 

His birth name -“Doctor Goldstein” - often lends itself to a unique conversation starter on first-time introductions.  

Known as Yitz, he was named after his grandfather, a PhD chemistry professor, also named Yitzchak, who everyone referred to as “Doctor" and passed away a few weeks before Yitz was born. 

The future Doctor Goldstein, MD, grew up in Hillcrest, Queens and went to Yeshiva’s High School, the Marsha Stern Talmudical Academy.  He went on to study in Israel for two years before returning to Queens to attend Lander College, where he was the president of the biological society and met his future wife, Mati.  He completed his medical training at the Albert Einstein College of Medicine, and went on to his pathology residency at Montefiore.  Dr. Goldstein lives in Riverdale with his wife and two children.

“I’m a guy who just grew up loving the sciences, who ended up in the sciences,” he said, noting that he is passionate about passing his enthusiasm on to his 5-year-old daughter.

“I get such great enjoyment out of explaining to her how a rainbow is made or how salt melts ice,” he added. 

On campus Dr. Goldstein takes part in Einstein’s career speed dating – talking to medical students about the diverse nature of pathology as career.

In his free, time he enjoys digitally editing photos for friends and family, and creating paper cut out art, which was displayed last year at Einstein's Ad-Libitum yearly Art Show.

A self-described science and computer geek, Dr. Goldstein is particularly interested in the technologies of molecular genetic pathology and the myriad ways with which current technologies manipulate DNA. 

“One day soon we’ll be able to take all of this genomic information and distill it to the point where we can tell a patient precisely what they are risk for” he said.

“The ways in which we will be able to precisely personalize medicine, utilizing all of the advanced technologies at our disposal, simply blows my mind every day.”