RISK AND BENEFIT: The beneficial effect of anticoagulant treatment is well established by numerous therapeutic trials demonstrating its usefulness in two main indications (venous thromboembolism and complete arrhythmia due to atrial fibrillation) in selected populations. Very few trials have been specifically conducted in elderly subjects and the increased risk of thrombosis and anticoagulant related bleeding cannot be used to extrapolate the results to elderly subjects. For this reason, a careful assessment of the initial risk and expected benefit must be made for each individual patient using a validated and systematic global evaluation system adapted for elderly subjects in order to better discern the indications and the risk of hemorrhage. PERSPECTIVES: The development of anticoagulation clinics, based on the method initiated by Professor Boneu at Toulouse, together with clinical trials designed to produce results transposable to the diverse and complex geriatric population, and finally the development of new oral compounds not requiring laboratory tests under the same conditions should help reduce the therapeutic risk for an equivalent benefit.