Abstract: Objective To analyze current stroke prevention measures for elderly patients with atrial fibrillation. Methods A retrospective analysis was conducted of the clinical records of elderly patients with atrial fibrillation treated in our hospital within the recent 5 years. The distribution of high risk factors for different age levels was studied, and the incidence of stroke and complications such as hemorrhage were compared between patients treated with warfarin and aspirin therapy. Results Compared with patients of 65 to 75 years old, the incidence of complications with other high risk factors was increased in advanced age group (over 75 years). Of these patients, 19.0% were treated with warfarin and 73.4% with aspirin. Compared with the aspirin group, stroke incidence was decreased significantly in warfarin group, which had simultaneously increased nonfatal hemorrhage. Conclusion Warfarin can be more effective than aspirin for stroke prevention in elderly patients with atrial fibrillation, but in clinical practice, the usage rate of warfarin still remains low with insufficient monitoring.