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We compared DOAC versus VKA treatment among patients with AF and recent stroke (&lt;3\u2009months) aged \u226585 versus &lt;85\u2009years. Primary outcome was the composite of recurrent stroke, intracranial hemorrhage (ICH) and all\u2010cause death. We used simple, adjusted, and weighted Cox regression to account for confounders. We calculated the net benefit of DOAC versus VKA by balancing stroke reduction against the weighted ICH risk.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In total, 5,984 of 6,267 (95.5%) patients were eligible for analysis. Of those, 1,380 (23%) were aged \u226585\u2009years and 3,688 (62%) received a DOAC. During 6,874 patient\u2010years follow\u2010up, the impact of anticoagulant type (DOAC versus VKA) on the hazard for the composite outcome did not differ between patients aged \u226585 (HR<jats:sub>\u226585y<\/jats:sub>\u00a0=\u20090.65, 95%\u2010CI [0.52, 0.81]) and\u2009&lt;\u200985\u2009years (HR<jats:sub>&lt;85y<\/jats:sub>\u00a0=\u20090.79, 95%\u2010CI [0.66, 0.95]) in simple (p<jats:sub>interaction<\/jats:sub>\u00a0=\u20090.129), adjusted (p<jats:sub>interaction<\/jats:sub>\u00a0=\u20090.094) or weighted (p<jats:sub>interaction<\/jats:sub>\u00a0=\u20090.512) models. Analyses on recurrent stroke, ICH and death separately were consistent with the primary analysis, as were sensitivity analyses using age dichotomized at 90\u2009years and as a continuous variable. DOAC had a similar net clinical benefit in patients aged \u226585 (+1.73 to +2.66) and\u2009&lt;\u200985\u2009years (+1.90 to +3.36 events\/100 patient\u2010years for ICH\u2010weights 1.5 to 3.1).<\/jats:p><\/jats:sec><jats:sec><jats:title>Interpretation<\/jats:title><jats:p>The favorable profile of DOAC over VKA in patients with AF and recent stroke was maintained in the oldest old. ANN NEUROL 2022;91:78\u201388<\/jats:p><\/jats:sec>","DOI":"10.1002\/ana.26267","type":"journal-article","created":{"date-parts":[[2021,11,8]],"date-time":"2021-11-08T10:16:52Z","timestamp":1636366612000},"page":"78-88","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Oral Anticoagulants in the Oldest Old with Recent Stroke and Atrial Fibrillation"],"prefix":"10.1002","volume":"91","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9475-2208","authenticated-orcid":false,"given":"Alexandros A.","family":"Polymeris","sequence":"first","affiliation":[{"name":"Department of Neurology and Stroke Center University Hospital Basel and University of Basel  Basel Switzerland"},{"name":"Neurology and Neurorehabilitation, University Hospital for Geriatric Medicine Felix Platter University of Basel  Basel 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