Aim To explore the ability of serum growth differentiation factor-15 (GDF-15) and the ABC (age, biomarkers, clinical history) bleeding risk score based on this in predicting hemorrhage events in elderly (age≥65 years) patients with non-valvular atrial fibrillation (NVAF) after oral administration of non-vitamin K antagonist oral anticoagulants (NOAC). Methods Elderly inpatients who were first diagnosed as NVAF and treated with NOAC were selected. The GDF-15 concentration in serum was analyzed and clinical data were collected in each enrolled patient. The ABC bleeding risk score was calculated, which is essential on biomarkers including GDF-15, and HAS-BLED bleeding risk score. The patients were divided into groups according to the occurrence of various bleeding events(major bleeding (MB), clinically relevant non-major gastrointestinal bleeding (CRNM-GIB),minor bleeding, and no bleeding events) during follow-up. The ABC bleeding risk score and HAS-BLED bleeding risk score were evaluated and compared for predicting various degrees of bleeding events groups. Results During the (19.92±6.83) months follow-up period, 49 cases (49/2,4.5%) had bleeding events, including 3 cases of cerebral hemorrhage, 19 cases of CRNM-GIB, and 27 cases of minor bleeding. Receiver operating characteristic (ROC)curve showed that serum GDF-15 concentration had predictive value in predicting CRNM-GIB (AUC 0.8,5%CI: 0.645～0.835, P＜0.001) and all bleeding events (AUC 0.0,5%CI:0.690～0.727, P＜0.001), and ABC bleeding risk score had predictive value in predicting CRNM-GIB (AUC 0.8,5%CI:0.552～0.824, P＜0.001) and all bleeding events (AUC 0.9,5%CI:0.579～0.779, P＜0.001).Compared with the HAS-BLED bleeding risk score, the ABC bleeding risk score had a higher ability to predict cerebral hemorrhage (AUC 0.8,5%CI:0.752～0.985 for ABC score vs. AUC 0.5,5%CI: 0.556～0.933 for HAS-BLED score, net reclassification improvement (NRI) 84.17%, P＝0.001), less ability to predict CRNM-GIB (AUC 0.8,5%CI:0.552～0.824 for ABC score vs. AUC 0.4,5%CI:0.639～0.849 for HAS-BLED score, NRI －23.96%, P＝0.025). Conclusion GDF-15 concentration in blood has predictive value for the bleeding risk of oral NOAC in elderly NVAF patients. Compared with HAS-BLED, ABC bleeding risk score can improve the ability to predict cerebral hemorrhage.