While the magnitude of venous thromboembolism (VTE) increases dramatically with advancing age, relatively little is known about the contemporary management of VTE in the elderly and the impact of age on associated short- and long-term outcomes. The objectives of this population-based study were to compare the clinical characteristics, treatment practices, and outcomes of subjects > or = 65 years with VTE to those of younger patients. The medical records of residents of the Worcester (MA, USA) metropolitan area with ICD-9 codes consistent with VTE during 1999, 2001, and 2003 were independently validated and reviewed by trained data abstractors. Information about patients' demographic and clinical characteristics, hospital management practices, and hospital and long-term outcomes was collected. There were a total of 1,897 validated events of VTE - 1,048 (55%) occurred in patients > or = 65 years of age. Patients > or = 65 years were less likely to have "unprovoked" VTE than younger patients. They were less likely to receive parenteral anticoagulation or warfarin as acute treatment. Rates of recurrent VTE did not differ significantly between patients 65 years of age or older compared to younger patients but the adjusted rates of major bleeding were increased approximately two-fold in older patients. In conclusion, advancing age is not a predictor of recurrent VTE but is associated with a significant increase in major bleeding episodes. Physicians treating elderly patients with VTE should continue to base their decisions on clinical characteristics previously shown to impact the risk of recurrent VTE. These decisions must be tempered by our observation that major bleeding occurs frequently in these patients.