Linder M, Iliadou Nyman A, Kieler H, et al. - In elderly patients with atrial fibrillation, researchers assessed connections between first-time use of direct oral anticoagulants or vitamin K antagonists and bleeding risk or mortality in a real-world setting in Sweden. The study population consisted of first-time users of dabigatran, apixaban, rivaroxaban, or warfarin over 60 years of age with first atrial fibrillation occurrence within 6 months prior to dispensing (2012– 2016). The matched study populations included 7,264 individuals for the direct thrombin inhibitors vs vitamin K antagonists comparison, 12,566 individuals for the direct factor Xa inhibitors vs vitamin K antagonists comparison and 6,606 individuals for the direct factor Xa inhibitors vs direct thrombin inhibitors comparison, in total 26,436 individuals. For women aged 75– 80, 80– 85, or above 85 years, for direct thrombin inhibitors vs vitamin K antagonists, numerically high, but imprecise, hazard ratios for gastrointestinal bleeding were found. In first-time users of direct thrombin inhibitors or direct factor Xa inhibitors, the reported increased risk of gastrointestinal bleeding is consistent with previous studies. In both sexes, across age groups, for naive and experienced anticoagulant users, excess mortality was observed and merits further study.