The very elderly patients with atrial fibrillation have a significantly higher risk of ischemic stroke compared with younger patients. The risk of bleedings also increases with age but in a lesser extent. Therefore, a net benefit of oral anticoagulants is higher in older adults with atrial fibrillation. Available evidence suggest that new oral anticoagulants (i.e. rivaroxaban, apixaban, dabigatran and edoxaban) that directly inhibit the coagulation factors effectively reduce the risk of thromboembolic complications in patients over 75 years of age with atrial fibrillation and have advantages over warfarin including safety issues, convenience of use, minor drug and food interactions, a wide therapeutic window, and no need for laboratory monitoring.