Venous Thromboembolism in Older Adults: A Community-based Study Frederick A. Spencer, MD, a,b Jerry H. Gurwitz, MD, b,c Sam Schulman, MD, a Lori-Ann Linkins, MD, a Mark A. Crowther, MD, a Jeffrey S. Ginsberg, MD, a Agnes Y.Y. Lee, MD, d Jane S. Saczynski, PhD, b,e Sonia Anand, MD, PhD, a Darleen Lessard, MS, e Cathy Emery, RN, b Wei Huang, MS, f Robert J. Goldberg, PhD e a Department of Medicine, McMaster University Medical Center, Hamilton, Ontario, Canada; b Department of Medicine, University of Massachusetts Medical School, Worcester; c Meyers Primary Care Institute, a joint endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Community Health Plan, Worcester; d Department of Medicine, Vancouver General Hospital, British Columbia, Canada; e Department of Quantitative Health Sciences and f Department of Surgery, University of Massachusetts Medical School, Worcester. ABSTRACT BACKGROUND: While the incidence of venous thromboembolism increases with age, little is known about its contemporary management or outcomes in older patients. Our goal was to compare the characteristics, treatment, and outcomes associated with venous thromboembolism, in patients aged 65-69 years, 70-74 years, 75-79 years, and 80þ years. METHODS/PARTICIPANTS: We prospectively followed 542 subjects aged 65 years with venous throm- boembolism from January 2008 through August 2011 at 6 sites. In addition, a retrospective study of 681 additional subjects aged 65 years with venous thromboembolism diagnosed in 2007 and 2009 was conducted at the same 6 sites. RESULTS: With advancing age, patients were more likely to suffer provoked venous thromboembolism but less likely to present with pulmonary embolism. Patients with unprovoked, provoked, or malignancy- associated venous thromboembolism received warfarin for a median of 401 days, 203 days, and 529 days, respectively. Age 80 years was not associated with an increased risk of recurrent venous thromboem- bolism, but there was an increased risk of all-cause mortality. CONCLUSION: With advancing age, patients are more likely to suffer hospital-associated and provoked venous thromboembolism. Many elderly patients with provoked or unprovoked venous thromboembolism were treated for >3 months or >12 months, respectively. Given that advanced age was not associated with increased risk of recurrent venous thromboembolism, but elderly patients in general have a higher risk of bleeding from continued anticoagulant therapy, such practice is potentially harmful. At the same time, such an argument could be used to more vigorously offer prophylaxis in the first place. Ó 2014 Elsevier Inc. All rights reserved.  The American Journal of Medicine (2014) 127, 530-537 KEYWORDS: Aged; Deep vein thrombosis; Elderly; Pulmonary embolism In the Worcester Venous Thromboembolism Study, the inci- dence rates of venous thromboembolism increased more than 10-fold in individuals aged 75 years, compared with patients aged <55 years. 1,2 Older patients represented 60% of all cases of venous thromboembolism occurring in residents of the Worcester (MA) area. Despite the high prevalence of venous thromboembolism in older subjects, relatively little is known about the clinical aspects of venous thromboembolism Funding: This work was supported by a grant from the National Institute of Aging (R01AG031083). JSS is supported by a grant from the National Institute of Health (K01AG033643). SA is supported by an Ontario Heart and Stroke Chair Award in Population Health Research and a Canada Research Chair in Ethnicity and Cardiovascular Disease. MAC is supported by a Career Investigator Award from the Ontario Heart and Stroke Foundation. Conflicts of Interest: None. Authorship: All authors had access to the data and played a role in writing this manuscript. Requests for reprints should be addressed to Frederick A. Spencer, MD, Department of Medicine, McMaster University e Faculty of Health Sci- ences, St. Joseph’s Healthcare, 50 Charlton Avenue East, Hamilton, ON L8N 4A6, Canada. E-mail address: fspence@mcmaster.ca 0002-9343/$ -see front matter Ó 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.amjmed.2014.02.011 CLINICAL RESEARCH STUDY