Atrial fibrillation (AF) is the most common chronic arrhythmia affecting approximately 9% of population. Gender-specific clinical predictors of maintenance of sinus rhythm or adequate rate control are sparsely investigated. Some data suggest gender differences in treatment and response to interventions. Findings from Framingham Heart Study showed sex-specific AF risk-factor-adjusted-odds for death is slightly higher in females than males. Sex differences are possible in the effectiveness of DOACs. Elderly female tended to bleed more with DOACs compared with warfarin, although the risk of bleeding in male was similar for DOACs and warfarin. To this regard, Rengo et al recommend that warfarin could be preferred in patients with high thromboembolic risk. Rivaroxaban may be more effective for stroke prevention compared with dabigatran and warfarin in men, but all 3 drugs seem to provide similar stroke prevention in female. Further studies are needed to understand whether lower rates of OAC use in the elderly female are associated with differences in clinical outcomes, and if so, action is needed to eliminate unnecessary differences in OAC use by sex.