Oral anticoagulation in elderly people is a complex problem. The decision to initiate anticoagulant therapy in a patient with atrial fibrillation require to balance potential benefits (decreased risk of ischemic stroke) and risks (major hemorrhage, in particular intracranial), in the context of each patient's specific characteristics. Once the patient has been informed, his/her preferences must be integrated into the treatment decision-making process. Current guidelines recommend anticoagulation in all patients aged 75 years and more with atrial fibrillation who do not have counterindications to this treatment. Patients aged 65 to 75 years should also receive an anticoagulation, especially those with cardio-vascular risk factors.