title: Venous thromboembolism in older adults: A community-based study.
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 80+ years.
  We prospectively followed 542 subjects aged ≥65 years with venous thromboembolism 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 thromboembolism, but there was an increased risk of all-cause mortality.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Medicine, McMaster University Medical Center, Hamilton, Ontario, Canada; Department of Medicine, University of Massachusetts Medical School, Worcester. Electronic address: fspence@mcmaster.ca.
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Spencer
authors.affiliation: Department of Medicine, University of Massachusetts Medical School, Worcester; Meyers Primary Care Institute, a joint endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Community Health Plan, Worcester.
authors.forename: Jerry H
authors.initials: JH
authors.lastname: Gurwitz
authors.affiliation: Department of Medicine, McMaster University Medical Center, Hamilton, Ontario, Canada.
authors.forename: Sam
authors.initials: S
authors.lastname: Schulman
authors.affiliation: Department of Medicine, McMaster University Medical Center, Hamilton, Ontario, Canada.
authors.forename: Lori-Ann
authors.initials: LA
authors.lastname: Linkins
authors.affiliation: Department of Medicine, McMaster University Medical Center, Hamilton, Ontario, Canada.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Crowther
authors.affiliation: Department of Medicine, McMaster University Medical Center, Hamilton, Ontario, Canada.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Ginsberg
authors.affiliation: Department of Medicine, Vancouver General Hospital, British Columbia, Canada.
authors.forename: Agnes Y Y
authors.initials: AY
authors.lastname: Lee
authors.affiliation: Department of Medicine, University of Massachusetts Medical School, Worcester; Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester.
authors.forename: Jane S
authors.initials: JS
authors.lastname: Saczynski
authors.affiliation: Department of Medicine, McMaster University Medical Center, Hamilton, Ontario, Canada.
authors.forename: Sonia
authors.initials: S
authors.lastname: Anand
authors.affiliation: Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester.
authors.forename: Darleen
authors.initials: D
authors.lastname: Lessard
authors.affiliation: Department of Medicine, University of Massachusetts Medical School, Worcester.
authors.forename: Cathy
authors.initials: C
authors.lastname: Emery
authors.affiliation: Department of Surgery, University of Massachusetts Medical School, Worcester.
authors.forename: Wei
authors.initials: W
authors.lastname: Huang
authors.affiliation: Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Goldberg
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D008297:Male; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000188:drug therapy / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D014859:Warfarin / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D014859:Warfarin
keywords: Aged; Deep vein thrombosis; Elderly; Pulmonary embolism