Atrial fibrillation (AF) is a disease of the elderly with a prevalence that increases with age from 0.1% in those younger than 55 years to 10% in those older than 80 years. Forty-five percent of patients with diagnosed AF are older than 75 years, and by 2050 about half of those with AF will be over 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 year olds to 36.2% in 80-89 year olds. In addition, elderly stroke patients have high rates of death and disability. With the aging of the population, atrial fibrillation and atrial fibrillation-associated stroke have become a serious social health problem. I. CONSENSUS 1. Assessment of stroke and bleeding risk is the key to choosing an appropriate anticoagulation strategy Risk factors for AF-related stroke and thrombotic risk include previous stroke, hypertension, diabetes, heart failure, women, vascular disease, and advanced age, among which advanced age and previous stroke are clinically relevant primary factors, and hypertension, diabetes, heart failure, women, and 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 AF, which included 1034 AF patients 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 heart disease, diabetes mellitus, 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). 2, Anticoagulation therapy reduces the risk of stroke in the elderly The most commonly used anticoagulant drugs are oral vitamin A inhibitors (VKA). When weighed against the risk of thrombosis and bleeding in older patients with AF, older people can still benefit from VKA anticoagulation. The Birmingham atrial fibrillation treatment of the aged study (973 patients aged 75 years or older with atrial fibrillation, mean age 81.5 years) demonstrated that warfarin (INR target 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 superiority of oral anticoagulants over dual antiplatelet agents (aspirin and clopidogrel) in high-risk AF stroke patients. II Controversy: the role of aspirin in antithrombotic therapy in elderly patients with atrial fibrillation 1. Antiplatelets in patients with atrial fibrillation and safety? 1) In elderly patients, aspirin antithrombotic therapy is not more efficacious than warfarin anticoagulation and increases the risk of gastrointestinal and major bleeding. The Birmingham Study of the Treatment of Atrial Fibrillation in the Elderly demonstrated 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-ever stroke over a 10-year period from 1999 to 2008 showed that antiplatelet therapy was not effective in preventing stroke compared with warfarin, and 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 and no safer than oral anticoagulants in elderly patients with atrial fibrillation. 2) Patients with CHA2DS2-VASc>=1 should be anticoagulated. Elderly elderly, with a preexisting major clinically relevant risk factor (age >= 75 years), should be anticoagulated (whether anticoagulation intensity is well managed with warfarin or new oral anticoagulants). III.CHALLENGES Warfarin increases the risk of bleeding, especially in elderly AF patients with fluctuating INR, making anticoagulation management more difficult. New oral anticoagulants offer new options. Dabigatran, a new OAC with a current rationale for use in elderly patients with AF, 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 with warfarin. A dose of 110 mg is recommended for treatment of elderly patients aged greater than or equal to 80 years in Canada and Europe.