**1. Introduction**

Atrial fibrillation (AF) is the most common supraventricular arrhythmia in the elderly in daily medical practice, with a correlation of decade-by-decade growth in the world population, being the onset and may also be part of various concomitant diseases that worsen the health of the population.

In the elderly patient, AF anticoagulation is used to prevent systemic embolic events (SEE) and stroke phenomena and their consequences; vascular dementia; worsening of heart failure (HF) and kidney function, among other pathologies.

In the indication of anticoagulation, the use of direct oral anticoagulants (DOACs) is gaining ground over treatment with vitamin K antagonist (VKA), this is due to their easy use of the indicated medication, their wide therapeutic window, the few adverse effects, and extensive support of scientific information that supports them.

The four large randomized pivotal works in Non-Valvular Atrial Fibrillation (NVAF) on anticoagulation [1–4] have included approximately 27,000 patients, mostly under 75 years of age, so later works were generated with observational evidence from the database in different countries on patients over 75 years of age, octogenarians and, a little less, in nonagenarians and patients over 90 years old.

Frailty has taken on a notorious relevance in recent decades due to the increase in life expectancy, thanks to improvements in the care of elderly patients, better medical treatments, and early diagnoses of comorbidities.

The age segment of nonagenarians has constant growth worldwide, and in addition, this group of patients, who suffer greater comorbidities and increase in embolic episodes, which can be prevented, gives rise to a dilemma that we hope to clarify, the fears of anticoagulation and the benefits of using DOACs.
