Cerebrovascular disease constitutes one of the major causes of death. Patients with atrial fibrillation are known to be at high risk for stroke. The efficacy of oral anticoagulant therapy in the primary prevention of stroke in individuals with nonvalvular atrial fibrillation has been demonstrated in several large randomized trials. However, many geriatricians remain reluctant to prescribe anticoagulants. This article focuses on the risks and benefits of stroke prophylaxis with anticoagulant therapy in elderly patients with nonvalvular atrial fibrillation.