Yasaka M, Yamashita T, Akao M, et al. - This prospective, multicenter, observational cohort investigation was carried out to assess patterns of anticoagulant utilization stratified by stroke and bleeding risk among elderly patients suffering from non-valvular atrial fibrillation (NVAF). For this purpose, the real-world All Nippon AF In the Elderly registry was used, and participants were 32,726 Japanese patients aged ≥ 75 years experiencing NVAF. A lower anticoagulant usage rate was noted in patients with high stroke and bleeding risks vs the low bleeding risk group; 8.7% and 5.8%, respectively, were not taking any anticoagulant. A higher usage of warfarin was reported in patients in the high bleeding risk group compared with the low bleeding risk group; time in the therapeutic range <40% was detected in more patients (14.0%) in the high bleeding risk group receiving warfarin vs those in the low bleeding risk group  (11.6%). Overall, presence of significant demographic as well as clinical disparities by bleeding risk was found in elderly NVAF patients at high stroke risk. Low-dose direct-acting oral anticoagulants were used frequently, but the dose distribution was not influenced by bleeding risk.