{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T04:22:07Z","timestamp":1747196527585,"version":"3.40.5"},"reference-count":22,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2024,5,24]],"date-time":"2024-05-24T00:00:00Z","timestamp":1716508800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100005205","name":"Janssen Research & Development, LLC","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100005205","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Thrombosis with thrombocytopenia syndrome (TTS) is a very rare prothrombotic disorder that is a safety concern for some COVID-19 vaccines. We aimed to devise a case definition to estimate the incidence of thrombosis with thrombocytopenia as a proxy for TTS in a national insurance claims database.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>We conducted a retrospective observational study using the National Health Insurance Research Database (NHIRD) in Taiwan over the three-year period prior to the SARS-COV-2 pandemic (2017\u20132019). Our case definition was all patients with newly diagnosed thrombosis co-occurring with a diagnosis of thrombocytopenia within seven days before or after the thrombosis diagnosis. Cases were identified using International Classification of Disease-10 codes.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Findings<\/jats:title>\n<jats:p>We identified 2010 patients with newly diagnosed thrombosis co-occurring with thrombocytopenia during the study period. The mean age was 64.71 years; female:male ratio 1:1.45. The most frequent thrombotic events were coronary artery disease (18.81%), cerebral infarction (16.87%), and disseminated intravascular coagulation (13.13%). Cerebral venous sinus thrombosis was rare (&lt;0.1%). The average annual incidence rate of co-occurring new diagnoses of thrombosis and thrombocytopenia was 2.84 per 100 000 population. Incidence rates were higher in men than women, except in 20\u201339 year-olds (higher in females). 20.6% of patients died within the first month after diagnosis.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Interpretation<\/jats:title>\n<jats:p>We observed that the demographic and clinical characteristics of thrombosis with co-occurring thrombocytopenia using our case definition is different from that of TTS. Further research is needed to refine the case definition of TTS in the post-COVID-19 vaccination period.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0301359","type":"journal-article","created":{"date-parts":[[2024,5,24]],"date-time":"2024-05-24T17:27:09Z","timestamp":1716571629000},"page":"e0301359","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["The incidence of thrombosis with co-occurring thrombocytopenia prior to the SARS-CoV2 pandemic: A population-based study"],"prefix":"10.1371","volume":"19","author":[{"given":"Yanfang","family":"Liu","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6339-0582","authenticated-orcid":true,"given":"Choo-Hua","family":"Goh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dereck","family":"Shen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hong","family":"Qiu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kuan-Chih","family":"Huang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Man","family":"Luo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhangjing","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0545-1567","authenticated-orcid":true,"given":"Chao-Hsiun","family":"Tang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2024,5,24]]},"reference":[{"key":"pone.0301359.ref001","doi-asserted-by":"crossref","first-page":"e2018062","DOI":"10.4178\/epih.e2018062","article-title":"Data resource profile: the National Health Insurance Research Database (NHIRD)","volume":"40","author":"LY Lin","year":"2018","journal-title":"Epidemiol Health"},{"key":"pone.0301359.ref002","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1111\/bjh.17613","article-title":"Vaccine-induced immune thrombotic thrombocytopenia (VITT)\u2014a novel clinico-pathological entity with heterogeneous clinical presentations","volume":"195","author":"M Lavin","year":"2021","journal-title":"Br J Haematol"},{"key":"pone.0301359.ref003","doi-asserted-by":"crossref","first-page":"10760296211068487","DOI":"10.1177\/10760296211068487","article-title":"Thrombosis with Thrombocytopenia Syndrome After Administration of AZD1222 or Ad26.COV2.S Vaccine for COVID-19: A Systematic Review","volume":"27","author":"U Waqar","year":"2021","journal-title":"Clin Appl Thromb Hemost"},{"key":"pone.0301359.ref004","doi-asserted-by":"crossref","first-page":"21501319221074450","DOI":"10.1177\/21501319221074450","article-title":"Cerebral Venous Sinus Thrombosis Following COVID-19 Vaccination: A Systematic Review","volume":"13","author":"V Jaiswal","year":"2022","journal-title":"J Prim Care Community Health"},{"key":"pone.0301359.ref005","unstructured":"Chen R, Buttery Monash J. Interim Case Definition of Thrombosis with Thrombocytopenia Syndrome (TTS) v10.16.4 Nov 11, 2021. https:\/\/brightoncollaboration.us\/wp-content\/uploads\/2021\/11\/TTS-Updated-Brighton-Collaboration-Case-Defintion-Draft-Nov-11-2021.pdf. Accessed 10 Feb 2022."},{"key":"pone.0301359.ref006","unstructured":"Shimabukuro T. Update: Thrombosis with thrombocytopenia syndrome (TTS) following COVID-19 vaccination. Advisory Committee on Immunization Practices (ACIP) May 12, 2021. https:\/\/www.cdc.gov\/vaccines\/acip\/meetings\/downloads\/slides-2021-05-12\/07-COVID-Shimabukuro-508.pdf Accessed 02 Mar 2022."},{"key":"pone.0301359.ref007","unstructured":"American Society of Hematology. Vaccine-induced immune thrombotic thrombocytopenia. https:\/\/www.hematology.org\/covid-19\/vaccine-induced-immune-thrombotic-thrombocytopenia. Accessed 02 Mar 2022."},{"key":"pone.0301359.ref008","unstructured":"British Society for Haematology. 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