Abstract: Objective To explore the clinical features and anticoagulant effect of elderly patients with atrial fibrillation(AF)and ischemic stroke. Methods A total of 165 elderly patients with AF were selected and divided into two groups according to occurrence of ischemic stroke. The clinical characteristics such as HAS-BLED score, CHA2DS2-VASc score, average age, combined disease were compared between elderly patients with and without ischemic stroke. The anticoagulant effect of elderly AF patients with ischemic stroke was evaluated. Results Of the 165 patients, 98 cases had ischemic stroke and 67 cases did not have ischemic stroke. The scores of HAS-BLED and CHA2DS2-VASc, average age, and ratios of cases with coronary heart disease, peripheral artery disease and heart failure in the elderly AF patients with ischemic stroke were significantly higher than those without ischemic stroke(P<0.05). All of the 98 elderly AF patients with ischemic stroke were treated with anticoagulant therapy, and 56 cases were treated with dabigatran and 42 cases were treated with rivaroxaban. After anticoagulant treatment, the frequency of AF attack was significantly reduced, and cerebral hemodynamic was significantly improved by brain CT examination. During anticoagulant therapy, only 4 cases had mild gastrointestinal discomfort, which could be relieved spontaneously. Conclusion For the elderly AF patients, older age, complicating with coronary heart disease, peripheral artery disease and heart failure are the risk factors of ischemic stroke. The elderly AF patients with ischemic stroke have a higher risk of bleeding and thrombosis. For these patients, the reasonable anticoagulant drugs should used to improve their clinical symptoms.