The prevalence of atrial fibrillation (AF) and the embolic risk increase with 
age. Elderly AF patients are undertreated with vitamin K antagonists (VKA). The 
new oral anticoagulants (NOAC) dabigatran, rivaroxaban and apixaban have been 
shown to be non-inferior to VKA for stroke prevention in AF. We summarize the 
knowledge about primary and secondary stroke prevention by NOAC in AF patients 
>75 years of age. A literature search was carried out using the terms 
'dabigatran', 'rivaroxaban', 'apixaban', 'elderly', 'octogenarians', 'atrial 
fibrillation' and 'anticoagulation' from 1998 to 2013. Randomized clinical 
trials, longitudinal studies, case series and case reports were included. 
Whereas studies investigating the use of VKA for stroke prevention in the 1990s 
were carried out by industry-independent institutions, all NOAC-investigating 
trials were sponsored by the manufacturers of the respective drugs. Frail 
elderly people were not represented in NOAC-investigating trials because of 
various exclusion criteria, and only one-third of patients were aged >75 years. 
A subgroup analysis from the dabigatran-investigating trial indicated that 
elderly patients might have a higher risk for extracranial bleeding 
complications with NOAC than with VKA. Further concerns about the use of NOAC in 
the elderly are the high prevalence of renal insufficiency in AF patients >75 
years of age, the largely unknown risk of drug-drug and drug-food interactions, 
the lack of easily available laboratory monitoring tests of anticoagulant 
activity and the lack of an antidote. There is a need for independent studies 
comparing the efficacy and risk of side effects of NOAC with that of VKA in 
elderly AF patients.