Henrard S, et al. - This retrospective cross-sectional study was performed to gain insight into the evolution of the underuse of anticoagulants, as well as to determine the factors related to this underuse, in older people with atrial fibrillation (AF) and a CHADS₂ score ≥ 2 since the introduction of direct oral anticoagulants (DOACs) to the market. Among study participants including geriatric patients admitted during the pre-DOAC (2008–2011) and post-DOAC (2013–2015) periods in an academic hospital in Belgium, it was obvious that anticoagulant underuse was primarily associated with antiplatelet use. Since DOAC marketing, a decline has been reported in the underuse of anticoagulant and in antiplatelet use. Underuse of anticoagulants was still a concern for three in ten geriatric patients with AF at high risk of stroke (CHADS₂ score ≥ 2).