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Objectives To determine the role of age-specific risk factors for thrombosis in older age, such as functional impairment. Design Case-control study. Setting The Age and Thrombosis-Acquired and Genetic risk factors in the Elderly Study, a two-center study conducted in the Netherlands and the United States from 2008 to 2011. Participants Individuals aged 70 and older with a first-time deep venous thrombosis in the leg or pulmonary embolism (n = 401) and controls aged 70 and older (n = 431) without a history of thrombosis. Exclusion criteria were active malignancy and severe cognitive disorders. Measurements The thrombotic risk associated with functional impairment, defined as impairment in two or more activities of daily living ( ADLs), impaired mobility (inability to walk outside), sedentary lifestyle (≥20 h/d sleeping or sitting), and low handgrip strength (<15th percentile), was assessed. Odds ratios ( ORs) adjusted for age, sex, and study center with 95% confidence intervals (95% CI) and population attributable risks ( PAR) were calculated. Results Risk of venous thrombosis was 2.9 times greater ( OR = 2.9, 95% CI = 1.6-5.3) in individuals with impairment in ADLs, three times as great ( OR = 3.0, 95% CI = 1.9-4.7) in those with impaired mobility, four times as great ( OR = 4.0, 95% CI = 2.5-6.3) in those with a sedentary life style, and 2.3 times as great ( OR = 2.3, 95% CI = 1.5-3.4) in those with weak handgrip strength. PARs were 8% for ADL disability, 13% for inability to walk outside for 15 minutes, 29% for sedentary lifestyle, and 13% for weak hand grip strength. Conclusion In individuals aged 70 and older, functional impairments are a major risk factor for venous thrombosis. These findings may help providers caring for older people be more aware of venous thrombosis risk. [ABSTRACT FROM AUTHOR]

Competing Interests: Competing interests: We have read and understood BMJ policy on declaration of interests and declare the following: SKJ reports grants and personal fees from AstraZeneca, Bayer, Boston Scientific, and Abbott; and grants from Jansen and Ted Med Co, outside the submitted work. RJM reports grants and personal fees from Amgen, Novartis, Merck, and Luitpold; grants from AstraZeneca, GSK, and Bayer; and personal fees from Boehringer Ingelheim during the conduct of the study. EP reports personal fees from UCB Pharma, Eisai Inc, GW Pharma, Mylan, Livanova, Sun Pharma, Sanofi, Takeda, and Medichem; and other from Wiley and Elsevier, outside the submitted work. The Health Services Research Unit, University of Aberdeen, receives core funding from the chief scientist office of the Scottish Government Health Directorates. FRR is a recipient of the NOW Spinoza award.

Importance: The effects of smoking on postoperative outcomes in patients undergoing major surgery are not fully established. The association between smoking and adverse postoperative outcomes has been confirmed. Whether the associations are dose dependent or restricted to patients with smoking-related disease remains to be determined., Objective: To evaluate the association between current and past smoking on the risk of postoperative mortality and vascular and respiratory events in patients undergoing major surgery., Design: Cohort study using the American College of Surgeons National Surgical Quality Improvement Program database. We obtained data on smoking history, perioperative risk factors, and 30-day postoperative outcomes. We assessed the effects of current and past smoking (>1 year prior) on postoperative outcomes after adjustment for potential confounders and effect mediators (eg, cardiovascular disease, chronic obstructive pulmonary disease, and cancer). We also determined whether the effects are dose dependent through analysis of pack-year quintiles., Setting and Participants: A total of 607,558 adult patients undergoing major surgery in non-Veterans Affairs hospitals across the United States, Canada, Lebanon, and the United Arab Emirates during 2008 and 2009., Main Outcomes and Measures: The primary outcome measure was 30-day postoperative mortality; secondary outcome measures included arterial events (myocardial infarction or cerebrovascular accident), venous events (deep vein thrombosis or pulmonary embolism), and respiratory events (pneumonia, unplanned intubation, or ventilator requirement >48 hours)., Results: The sample included 125,192 current (20.6%) and 78,763 past (13.0%) smokers. Increased odds of postoperative mortality were noted in current smokers only (odds ratio, 1.17 [95% CI, 1.10-1.24]). When we compared current and past smokers, the adjusted odds ratios were higher in the former for arterial events (1.65 [95% CI, 1.51-1.81] vs 1.20 [1.09-1.31], respectively) and respiratory events (1.45 [1.40-1.51] vs 1.13 [1.08-1.18], respectively). No effects on venous events were observed. The effects of smoking mediated through smoking-related disease were minimal. The increased adjusted odds of mortality in current smokers were evident from a smoking history of less than 10 pack-years, whereas the effects of smoking on arterial and respiratory events were incremental with increased pack-years., Conclusions and Relevance: Smoking cessation at least 1 year before major surgery abolishes the increased risk of postoperative mortality and decreases the risk of arterial and respiratory events evident in current smokers. These findings should be carried forward to evaluate the value and cost-effectiveness of intervention in this setting. Our study should increase awareness of the detrimental effects of smoking-and the benefits of its cessation-on morbidity and mortality in the surgical setting.

Objectives: To study whether exercise is associated with the risk of venous thrombosis in elderly people., Design: Observational study with a median follow-up of 11.6 years., Setting: The Cardiovascular Health Study in four U.S. communities., Participants: People aged 65 and older without prior venous thrombosis (deep venous thrombosis or pulmonary embolism)., Measurements: Self-reported exercise was measured two or three times during follow-up and was defined as expending more than 500 kcal/wk on exercise, including walking for exercise. Venous thrombosis cases were verified using medical record review., Results: Of 5,534 participants, 171 developed a first venous thrombosis. Self-reported exercise at baseline was not related to the risk of venous thrombosis after adjustment for sex, age, race, self-reported health, and body mass index (adjusted hazard ratio (HR(adj))=1.16, 95% confidence interval (CI)=0.84-1.61), although with exercise modeled as a time-varying exposure, overall results were in the direction of greater risk of venous thrombosis (HR(adj)=1.38, 95% CI=0.99-1.91). For mild-intensity exercise, such as walking, there was a nonsignificant finding in the direction of benefit (HR(adj)=0.75, 95% CI=0.49-1.16), but strenuous exercise, such as jogging, was associated with greater risk of venous thrombosis (HR(adj)=1.75, 95% CI=1.08-2.83) than no exercise at all., Conclusion: In elderly people, strenuous exercise was associated with a higher risk of venous thrombosis than no exercise at all. Future studies are needed to explain this unexpected higher risk.