Atrial fibrillation is a disease of the elderly, with prevalence increasing with age from 0.1% in those younger than 55 years to 10% in those older than 80 years. Forty-five percent of patients diagnosed with atrial fibrillation are older than 75 years of age, and by 2050 approximately half of all patients with atrial fibrillation will be older than 80 years of age. Ischemic stroke and thromboembolism are major complications of AF, and in the Framingham study, stroke due to AF increased with age, from 6.7% in 50-59 years to 36.2% in 80-89 years. In addition, there is a high rate of death and disability in older stroke patients. As the population ages, atrial fibrillation and atrial fibrillation-related stroke have become a serious social health problem. The risk factors for atrial fibrillation-related stroke and thrombosis include previous stroke, hypertension, diabetes, heart failure, female, vascular disease, and advanced age, among which advanced age and previous stroke are the main clinically relevant factors, and hypertension, diabetes, heart failure, female, and vascular disease are the secondary risk factors. Vascular disease are secondary risk factors (CHA2DS2-VASC, ECS Guidelines for the Management of Atrial Fibrillation, 2010). We recently completed a survey of elderly Chinese with atrial fibrillation that included 1034 patients with atrial fibrillation, with a median age of 75 years and 27.1% women. The survey showed that hypertension was the most common complication in this group of elderly Chinese patients with AF, followed by coronary artery disease, diabetes, heart failure, previous stroke, and vascular disease. Further univariate and multifactorial analyses showed that vascular disease was the main independent risk factor (HR,3.07, 95% CI, 1.64-9.11). Anticoagulation reduces the risk of stroke in the elderly The most commonly used anticoagulant is an oral vitamin A inhibitor (VKA). After weighing the risk of thrombosis and bleeding in elderly patients with atrial fibrillation, older adults may still benefit from VKA anticoagulation therapy. The Birmingham atrial fibrillation treatment of the aged (973 patients with atrial fibrillation aged 75 years or older, mean age 81.5 years) showed that warfarin (INR target value 2-3) was effective in preventing stroke even in elderly patients with atrial fibrillation aged 75 years or older. The ACTIV-W study also demonstrated the superior efficacy of oral anticoagulants over dual antiplatelet (aspirin and clopidogrel) in patients with high-risk AF stroke. II. Controversy: the role of aspirin in antithrombotic therapy in elderly patients with atrial fibrillation 1. antithrombotic effect and safety of antiplatelets in patients with atrial fibrillation? (1) In elderly patients, aspirin antithrombotic therapy is not more effective than warfarin anticoagulation and increases the risk of gastrointestinal and major bleeding. The Birmingham Geriatric Atrial Fibrillation Treatment Study showed a lower incidence of stroke, other systemic thrombosis, and intracranial hemorrhage in the warfarin-treated group than in the aspirin-treated group (relative risk, RR, 0.48; 95% CI, 0.28-0.80; P=0.003). A UK survey of 32,151 patients with a first stroke over 10 years from 1999 to 2008 showed that antiplatelet therapy was not effective in preventing stroke compared with warfarin and that patients had an increased thrombotic risk score (CHADS2). (2) Dual antiplatelet therapy is superior to aspirin alone for stroke prevention, but also increases the risk of major bleeding. 2. New perspectives on antithrombotic therapy: 1) Aspirin is no more effective than oral anticoagulants and no safer than oral anticoagulants in elderly patients with atrial fibrillation. 2) Patients with CHA2DS2-VASc>=1 should be treated with anticoagulation. Older age, with an existing major clinically relevant risk factor (age >= 75 years), should be treated with anticoagulation (either warfarin or a new oral anticoagulant with good anticoagulation intensity management). III. Challenges Warfarin increases the risk of bleeding, especially in older patients with AF with fluctuating INR, making anticoagulation management more difficult. New oral anticoagulants offer new options. Dabigatran is a new OAC that currently has a rationale for use in elderly patients with AF, and it is a direct thrombin inhibitor. It does not increase the risk of intracranial hemorrhage in elderly patients, but has a similar or higher risk of extracranial hemorrhage compared to warfarin. In Canada and Europe, a dose of 110 mg is recommended for elderly patients aged 80 years or older.