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Objective: To analyze the clinical features of elderly patients with polythemia vera (PV)., Methods: Statistical analyses were performed for the clinical features of 68 PV patients of age≥60 years and 72 PV patients of age<60 years from January 2009 to December 2013 in our hospital., Results: Compared with younger patients, elderly patients with PV had higher incidences of thrombosis (54.4% (37/68) vs 30.6% (22/72), P=0.004), more risk factors of cardio-cerebrovascular (63.2% (43/68) vs 36.1% (26/72), P=0.001), higher white blood cell counts ((13.9±3.8)×10(9)/L vs (7.8±2.2)×10(9)/L, P=0.000) and higher JAK2 V617F allele burden (62% (30%-81%) vs 41% (26%-63%), P=0.035). There was higher incidences of vascular complications in elderly patients with PV (54.4% (37/68) vs 30.6% (22/72), P=0.004). Myelofibrosis transformation occurred with higher frequency in elderly patients with PV (11.8% (8/68) vs 2.8% (2/72), P=0.039). And there was no significant difference in the frequency of leukemia transformation between elderly patients and younger patients (4.4% (3/68) vs 0 (0/72), P=0.112). There was higher mortality rate in elderly patients with PV (14.7% (10/86) vs 4.2% (3/72), P=0.032)., Conclusions: There are more risk factors in elderly patients with PV. The elderly patients with PV has high risk to complicat with thrombosis and transformated to myelofibrosis and leukemia. Prevention or delay of these complications is currently the goal of treatment, so that it could reduce the mortality rate and disease progression.