Talk:Embolic and thrombotic events after COVID-19 vaccination

A quite convincing preprint

Twitter thread, direct link. TL;DR: a mouse model shows that VITT happens if, and only if adenovirus vector enters the blood stream after an accidental intravenous injection, because then platelets and adenovirus stick together and are attacked by the immune system together. Yes, I didn't expect it be that simple either. Ain92 (talk) 11:33, 1 July 2021 (UTC)

• And BTW, in replies I found this video from April discussing the same thing and it seems that this hypothesis was proposed as early as mid-March in Denmark. Ain92 (talk) 12:19, 1 July 2021 (UTC)

Requested move 18 December 2021

The following is a closed discussion of a requested move. Please do not modify it. Subsequent comments should be made in a new section on the talk page. Editors desiring to contest the closing decision should consider a move review after discussing it on the closer's talk page. No further edits should be made to this discussion.

The result of the move request was: Not Moved Mike Cline (talk) 15:45, 11 January 2022 (UTC)

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Embolic and thrombotic events after COVID-19 vaccination → Vaccine-induced immune thrombotic thrombocytopenia – The current name makes it difficult to find the article, causes it to not show up in Google searches, and violates WP:UCRN (and WP:OR?) Omegatron (talk) 16:40, 18 December 2021 (UTC)

• We should use one of the five names used in academia/medicine, of which "Vaccine-induced immune thrombotic thrombocytopenia (VITT)" appears to be the most accurate and most commonly-used in Google Scholar searches. I think "Thrombosis with thrombocytopenia syndrome (TTS)" is more vague and so should not be used. The others are all synonymous, so we should go with whichever is most well-known.

• This Thrombosis Research article discusses the names:

  We believe the name “VITT” works well, for two reasons. First, the term clearly denotes the key features of the disorder, and the sequence of letters provides a useful mnemonic for disease recognition in the usual sequence of events: … Second, the term “VITT” itself need not mandate that thrombosis be present … Another term used in the United States … “TTS” … highlights the two key clinical features of thrombosis and thrombocytopenia but without denoting either preceding vaccination or alluding to its immune-mediated pathogenesis. This term has limited clinical utility, since many conditions … present with the duad of thrombosis and thrombocytopenia

• The Lancet Haematology says:

  Although initially several terms were used to describe the syndrome, such as vaccine-associated thrombosis with thrombocytopenia and vaccine-induced prothrombotic immune thrombocytopenia, the term that has gained widespread use is vaccine-induced immune thrombotic thrombocytopenia (VITT). Thrombosis with thrombocytopenia syndrome has also been used, but it is a more general term that can be caused by other conditions, such as antiphospholipid syndrome and thrombotic thrombocytopenic purpura.

• UpToDate has a summary of the latest information: COVID-19: Vaccine-induced immune thrombotic thrombocytopenia (VITT)

  VITT antibodies bind to platelets via an eight amino acid region of PF4 on the platelet surface, located within the heparin binding site [4]. VITT antibody binding is blocked by heparin. The amino acids bound by VITT antibodies overlap with but differ from the amino acids bound by HIT antibodies, and VITT antibody binding to platelets is stronger than HIT antibody binding. … Other adenoviral vaccines have been administered to large numbers of individuals without reported cases of VITT. Examples include Ad5-based COVID-19 vaccine (CanSino Biologics), Gam-COVID-Vac/Sputnik V (Gamaleya Institute), and Ad26.ZEBOV-GP (recombinant) Ebola vaccine (Janssen Biologics).

• Article from November 2021:

  VITT is an immune-based complication of adenoviral-based vaccines used to immunize against SARS_CoV2.

• Article from November 2021:

  The ChAdOx1 nCoV-19 vaccine has been shown to induce Vaccine-induced Immune Thrombotic Thrombocytopenia (VITT)

— Omegatron (talk) 16:40, 18 December 2021 (UTC)

— Relisting. Djm-leighpark (talk) 08:43, 3 January 2022 (UTC)

Note: WikiProject COVID-19 has been notified of this discussion. — Shibbolethink ^{(♔ ♕)} 16:45, 18 December 2021 (UTC)

Note: WikiProject Medicine has been notified of this discussion. — Shibbolethink ^{(♔ ♕)} 16:45, 18 December 2021 (UTC)

Note: WikiProject Pharmacology has been notified of this discussion. — Shibbolethink ^{(♔ ♕)} 16:45, 18 December 2021 (UTC)

Support. Agree VITT is the more common term and the one used among experts. — Shibbolethink ^{(♔ ♕)} 16:46, 18 December 2021 (UTC)

 Comment: the article in Thrombotic Research comes to the following conclusion (they use a lot more scientific reasoning as well, that I'm omitting for copyright's sake):

We believe the name “VITT” works well, for two reasons. First, the term clearly denotes the key features of the disorder, and the sequence of letters provides a useful mnemonic for disease recognition in the usual sequence of events...Second, the term “VITT” itself need not mandate that thrombosis be present

— Shibbolethink ^{(♔ ♕)} 17:02, 18 December 2021 (UTC)

Thanks for the source. They also argue against "TTS", for not "denoting either preceding vaccination or alluding to its immune-mediated pathogenesis" and say it has "limited clinical utility, since many conditions…present with the duad of thrombosis and thrombocytopenia" — Omegatron (talk) 17:24, 18 December 2021 (UTC)

• Comment: There is the question if Covid-19 should be removed from the title or not (and that fundamentally alters the scope of the article. There is also the question we are looking at adenovirus based vaccines or not. And article content needs to match the title. Now there is a claim the event is linked to the adenovirus. [1], (Not a MEDRS source but there may be a MEDRS source behind it). It should be noted a lot of the article relates to research back from April 2021; and relatively little from recent months has been included. Thankyou. Djm-leighpark (talk) 18:01, 18 December 2021 (UTC)

I am generally opined as a non-profession that (Long, Bridwell & Gottliib, 2021)[2] title Thrombosis with thrombocytopenia syndrome associated with COVID-19 vaccines fairly well encompasses what the article is currently about. Djm-leighpark (talk) 20:36, 18 December 2021 (UTC)

• Leaning oppose: The proposed name asserts a cause-and-effect relationship that is not in the current title and does not seem fully established. It also changes the scope substantially, to include non-COVID-19 vaccinations. —⁠ ⁠BarrelProof (talk) 19:11, 18 December 2021 (UTC)

  I was wondering about the concern raised by @BarrelProof. The "Vaccine-associated thrombotic thrombocytopenia" (VATT) name (mentioned in the paywalled article above) doesn't declare a cause-and-effect relationship, so I was leaning that direction. However, PMID 34407607 (review article published in June in a reputable medical journal) seems to consider the connection settled, at least with respect to two of the vaccines, so perhaps that's not as important as my first thought suggested. WhatamIdoing (talk) 20:30, 18 December 2021 (UTC)

  If future research changes the name to "Adenovirus-induced immune thrombotic thrombocytopenia" or something like that, then we can rename the article at that time. But for now, this is the generally-accepted term for the syndrome, so the article title should reflect that. — Omegatron (talk) 16:17, 19 December 2021 (UTC)

• FYI, "induced" asserts a cause-and-effect relationship. —⁠ ⁠BarrelProof (talk) 20:30, 19 December 2021 (UTC)

  Yes, and I think at this point the consensus of experts is that there is a cause and effect relationship with certain vaccines. A rare event, but still a cause and effect. Getting the vaccine increases your risk of having a thrombotic event. Same with the virus itself, but likely via different mechanisms. — Shibbolethink ^{(♔ ♕)} 21:35, 19 December 2021 (UTC)

  So you're opposed to the name because you don't believe there's a cause and effect relationship? — Omegatron (talk) 15:27, 20 December 2021 (UTC)

I expressed multiple concerns. If you look a little earlier in the conversation you'll see what I said. —⁠ ⁠BarrelProof (talk) 22:09, 21 December 2021 (UTC)

• Oppose: I believe its important to review the language the World Health Organisation (WHO), European Medicines Agency (EMA), and similar agencies trusted by WHO, e.g. UK MHRA who judge consensus of experts. In general I believe they are not using VIIT; certainly not in communications to the public as far as I am aware. In particular these risks are now reported on the advice leaflets with the medicines on EMA / (UK)MHRA Janssen: [3], [4][5], [6] & EMA / (UK)MHRA Vaxzevria: [7], [8], [9]. VIIT is not in the terminlogy in use. I'd also note that the relevant agencies are fully accepting some the high likihood of the specific Coivd-19 vaccinations correlating to the occurrence of some specific disorders in a small number of cases, i.e. rarely. There is also a case that these rare risks, not better quantified, can be handled within each article, whicch was not necessarily the case March/April 2021. 01:30, 20 December 2021 (UTC) — Preceding unsigned comment added by Djm-leighpark (talk • contribs)

  What term do those organizations use, then? The links you posted just describe the problem, rather than giving it a name. "Thrombosis (formation of blood clots in the blood vessels) in combination with thrombocytopenia (low levels of blood platelets) and Guillain-Barré syndrome (a neurological disorder in which the body’s immune system damages nerve cells) may affect up to 1 in 10,000 people". In technical documents they use VITT, too: https://www.gov.uk/government/publications/clinical-investigation-and-management-of-covid-19-vaccine-induced-thrombosis-and-thrombocytopenia — Omegatron (talk) 15:27, 20 December 2021 (UTC)

• Oppose: This page is clearly about effects following Covid-19 vaccination, not general vaccination. Taking out Covid-19 from the title will just cause more confusion. ^{(♔ ♕)}15:04, 20 December 2021 (UTC)

  Are there other vaccines that cause this effect? COVID vaccines and Zabdeno are the only approved adenovirus vector vaccines so far? We should be using the term most commonly used in medical literature, not inventing a new term that isn't used by any professionals. — Omegatron (talk) 15:27, 20 December 2021 (UTC)

• Oppose - last two words used in the new location target are not words we use every day. Include Covid-19 or similar in the title is better for everyone instead of using rarely used words. Iggy (Swan) (Contribs) 22:02, 20 December 2021 (UTC)

  "Embolic" and "thrombotic" are words we use every day? Or are you proposing a different article title? — Omegatron (talk) 22:11, 20 December 2021 (UTC)

• Support. The consensus by the relevant experts is that this phenomenon should be labelled VITT. So far it seems to be unique in COVID-19 vaccines but that is not guaranteed, as both adenoviral and mRNA vaccines are likely to be continued to be used for other infections. JFW | T@lk 13:33, 21 December 2021 (UTC)
• Comment: I am concerned with disruptions to this discussion. If I view the changes in the nomination between when I made this first comment: Special:Diff/1060950319, my oppose !vote at Special:Diff/1061163539, and a recent edit at Special:Diff/1061467924 by nominator Omegatron doing significant undated modifications such as Special:Diff/1061246417. There is a question if people have arrived here due to an undue CANVAS. Ultimately Vaccine-induced immune thrombotic thrombocytopenia (VITT) (main definition of acronym?) has been subject to BLUDGEONing, and responses so far in this matter on expect consensus are somewhat VAGUEWAVE. These's money and kuos in Coivd-19 vaccines; and some excellent research in this syndrome and vaccine cost/risk/benefit; the article perhaps lagging some newer information; though discussion and improved sourcing on the article in the past few days is welcome. I have reconsidered over the past few days whether the article should be put up deletion or merger; I have moved away from those thoughts. I do accept the title is best moved from the name Embolic and thrombotic events after COVID-19 vaccination, I think I am further moving to the view COVID-19 is probably best removed from the title. The entomology of the syndrome is interesting to say the least. I have some thoughts Vaccine-induced immune thrombotic thrombocytopenia may be the best title, but I WHO/EMA/MHRA(UK) acknowledge but seem reluctant to use VIIT, possibly for vaccine hesitancy reasons? ... seeming to prefer (Post vaccination) Thrombosis with Thrombocytopenia Syndrome (TTS) even in this document updated in December 2021 for example. Thankyou. Djm-leighpark (talk) 09:01, 22 December 2021 (UTC)

  What's the WP:CANVAS concern? Advertising on wikipedia project talk pages? Or something else? — Shibbolethink ^{(♔ ♕)} 12:43, 22 December 2021 (UTC)

Nom. contacted a number of poeple [10] .. e.g. Special:Diff/1061321198 with the comment: "Hi, you're one of the top 10 contributors to this article" whilst linking to xtools. I have concerns some who were in the top ten on xtools at the time were no contacted, while others who were outside the xtools top ten 'at the time were. The detailed analysis of that would be tough because even xtools has multiple metrics. In practice from the point of the likely this specific move !vote outcome the deep analysis of that does not look relevant. 09:57, 28 December 2021 (UTC) — Preceding unsigned comment added by Djm-leighpark (talk • contribs)

• Oppose. I agree that the current title is not the best, but the proposal is no better. We need an article COVID-19 vaccination side effects or similar. Maybe rescope this article to be the basis of that? Andrewa (talk) 22:08, 27 December 2021 (UTC)

@Andrewa: Respectfully disagree with re-scoping this article to COVID-19 vaccination side effects; basically those are covered in the Wikipedia:Manual of Style/Medicine-related articles#Content sections of each individual vaccine. But if you do want to do that I'd suggest a clean slate TNT fresh start to a clearer less (potentially) biased overview. But it is a valid question where does the article go from here (given the rename is likely opposed currently); and after that is made certain the best plausible name is chosen. Thankyou. Djm-leighpark (talk) 10:09, 28 December 2021 (UTC)

We are a general encyclopedia. All of our articles should be titled and written with the general reader in mind. Neither the current nor proposed titles are recognisable to this audience. And that is a problem. What is your solution to it? Andrewa (talk) 06:34, 29 December 2021 (UTC)

Needing to use the old Pluralis Majestatis and a shout of all to get the argument across? To re-state idea, possibly I accept poorly put, in the section #Confirmation article scope is to remain unchanged? below, its best to confirm the current scope of this article, or any future direction of its scope, and then get changed to a new name to reflect that scope. when its confirmed what that scope is as you are certainly questioning it. Both of those things are determined by consensus, even if I don't like the consensus, I go with it. While I think an article COVID-19 vaccination side effects is not a great idea due to high risks of POV, failure to adhere to say MEDRS, monetary considerations for vaccine manufactures, or simply failing to be fit for mainspace and maintaining accuracy there is nothing to stop whatsoever one being drafted or even presented, possibly needfully via AfC for additional eyes prior to mainspace. I believe this specific move proposal likely dead at this time, but the issues behind it remain. Feel free to add to the discussion below, start an alternative discussion, or make a specific proposal, or start the article you suggest. Thankyou. Djm-leighpark (talk) 08:22, 29 December 2021 (UTC)

• Comment: Despite being listed at RM nothing's happened, this proposal is effectively dead/statement, and could be DRV'd due to irregularties by the nominator. I hope therefore a neutral can put it out of its misery. Thankyou. Djm-leighpark (talk) 19:18, 9 January 2022 (UTC)

The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

User:Djm-leighpark: "Irregularities"? For notifying the main contributors to the article, to get more opinions on the move? I had no idea whether they would be supportive or not.

This title is still obviously bad. Can we come up with a better one? If I Google for "vitt", this article is on the third page of results. If I search for "tts syndrome", it's on the fourth page of results. People aren't going to search for this made-up term that isn't used anywhere in the medical literature or mentioned anywhere in the news.

The term isn't exclusive to COVID, either, so that shouldn't be in the title: "We report a case of VITT following HPV vaccination. This should raise awareness of the possibility of VITT also occurring after other vaccines, not exclusively adenoviral vector-based SARS-CoV-2 vaccines." — Omegatron (talk) 14:22, 15 January 2022 (UTC)

Given the closer's comment it probably better to discuss things with them first if contemplating a move review. Personally I'd see the only way out of this as a mediated discussion because people will likely be zinging this way and taht, with consensus hard. Thankyou. Djm-leighpark (talk) 21:58, 15 January 2022 (UTC)

To be clear to anyone who is interested I have maintained discussion impetus at RL cost and have made my views known to the closer at Special:Diff/1066136690. Thankyou. Djm-leighpark (talk) 00:25, 17 January 2022 (UTC)

Confirmation article scope is to remain unchanged?

While I was was not up to speed with where this article had got to when I reverted the BOLD good faith move on 19 December 2021 at Special:Diff/1060935121 I have since become incline to believe there are some indications of appetite to retain the article and there is some appetite to change the article name. But first it is necessary to confirm the scope of the article is correct, or that in needs to be modified. I personally am minded the current article scope is correct, and is defined by Thrombosis with Thrombocytopenia Syndrome (TTS) post vaccination sometimes termed Vaccine-induced immune thrombotic thrombocytopenia (VITT). The rare event syndrome seems probably associated with (certain?) adenovirus class vaccines, which are mainly currently used in COVID-19 vaccinations. In essence, does the current article scope correct? Thankyou. Djm-leighpark (talk) 10:31, 28 December 2021 (UTC)

Pfizer studies could be included in summary

Proposed text:

Thrombosis and thrombosis with thrombocytopenia syndrome (TTS), may also occur with Pfizer COVID-19 vaccine and Moderna COVID-19 vaccine.Thrombosis and thrombosis with thrombocytopenia syndrome (TTS), may also occur with Pfizer COVID-19 vaccine and Moderna COVID-19 vaccine.

References

• WP:MEDPOP and primary sources. We should use WP:MEDRS. Alexbrn (talk) 14:09, 30 December 2021 (UTC)
• I am pleased the discussion was brought here rather than continuing editing of the article. I share Alexbrn's concerns. I am not completely au-fait with this area, but I do not read (Barta N, et al) as supporting the proposed content; Jerusalem Post mentions TTP not TTS; Fiocruz & Oxford seems about CVT ( And it seems I was at higher risk of an RTA or the missus murdering me on the way to the vaccination centre than of getting CVT post vaccination). But this goes to show need to define scope of this article per section above. Thankyou. Djm-leighpark (talk) 14:49, 30 December 2021 (UTC)

• this link below

It reports that Moderna and Pfizer vaccines (mRNA as the Update PDF call it), 6 cases of "potential CVST incident cases, but all without thrombocytopenia " Disease "cerebral venus sinus thrombosis" is a very rare blood clot in the brain "venous sinuses". TTP may be associated with CVST, that is, TTP and CVST can occur at the same time, but it is rare. "Thrombocytopenia" is a bood disorder. In the PDF above it is specifically about the Janssen vaccine, of course other information are included, still the only non-mRNA vaccine approved at the time of the published update in the United States: May 2021, it was Janssen COVID-19 vaccine.

• Jerusalem Post report the government official stating (citing?) study that rare effect mRNA Pfizer vaccine may cause TTP. The source of the study looks like this one https://www.hematology.org/covid-19/vaccine-induced-immune-thrombotic-thrombocytopenia

The study also mentions immune thrombocytopenia. Regarding both "Advisory Committee on Immunization Practices (ACIP)" and the Hematology study, both mRNA vaccines are linked, although rare obviously, to "thrombotic" and blood disorders generally speaking for what I understand. If I'm wrong please edit and delete, tell me to delete and correct.

Newest study which is broad and technical https://www.thelancet.com/journals/lanepe/article/PIIS2666-7762(21)00256-8/fulltext

Achezet (talk) 15:08, 30 December 2021 (UTC)

• Oppose: Pfizer seems not to come into the picture per (ACIP/CDC 14 May 2021) "No confirmed cases of incident CVST with thrombocytopenia after 6.3

million doses of mRNA COVID-19 vaccines administered in VSD". I really dont get this area well but seems sources are a complete mess for someone to wade through here. I believe CVST without thrombocytopenia is outside of article scope. Thankyou. Djm-leighpark (talk) 17:11, 31 December 2021 (UTC)