Aim To investigate the clinical effect of dabigatran etexilate versus warfarin double anticoagulation scheme in antithrombotic therapy for elderly patients with atrial fibrillation (AF) and coronary heart disease (CHD). Methods 198 elderly patients with AF complicated with CHD treated in our hospital from August 2018 to December 2019 were selected as the research objects. Using random number table method, the patients were divided into observation group and control group with 99 cases in each group. The observation group was treated with dabigatran etexilate, while the control group was treated with warfarin combined with antiplatelet drugs (aspirin). Follow-up for one year, the curative effect of antithrombotic therapy was compared between the two groups. The prothrombin time (PT), international normalized ratio (INR), thrombin time (TT), activated partial thromboplastin time (APTT), fibrinogen (Fib), D-dimer (D-D), platelet count (PLT) and C-reactive protein (CRP) were compared between the two groups before treatment and 1,6 and 12 months after treatment. The thrombotic event, bleeding event and adverse drug reaction were observed and recorded in the two groups. Results After 1,6 and 12 months of treatment, the PLT, CRP and D-D levels showed a gradual and obvious downward trend in the observation group and the control group (F＝42.7,8.4,4.582, all P＜0.001). Compared with before treatment, PT, INR, TT, APTT and Fib were significantly improved in the two groups (F＝356.1,5.9,2.6,5.7,5.623, all P＜0.001). Serum uric acid levels in both groups decreased significantly (F＝105.515, P＜0.001), and the degree of decrease in the observation group was more significant than that in the control group (F＝145.854, P＜0.001). After treatment, the incidence of bleeding in the observation group was 5.05%, which was significantly lower than 21.21% in the control group (χ²＝11.335, P＝0.001). Conclusion The effect of dabigatran etexilate in antithrombotic therapy of elderly patients with AF and CHD is similar to that of warfarin double anticoagulation scheme, but the incidence of bleeding event is lower and the safety is higher, so it can be used as an ideal choice for clinical antithrombotic therapy of elderly patients with AF and CHD.