Atrial fibrillation (AF) affects approximately 2.2 million patients in the United States (US). The median age of patients with AF is 75 years, with a prevalence of around 9% in the elderly . In the US alone, it is projected that 5.6 million people will be diagnosed with non-valvular AF by 2050, of whom approximately 50% will be over 80 years of age . The proportion of ischemic strokes attributable to AF rises significantly with age, from 1.5% in those aged 50-59 to 23.5% in those aged 80-89 . Strokes in AF are associated with a higher mortality and disability than stroke from other causes . Given the high prevalence of AF in the elderly, multiple comorbidities in many of these patients, and the greater risk of thromboembolism coupled with heightened concerns about bleeding, a specific review of the data and gaps in knowledge regarding anticoagulation for AF in older patients is in order.