Objective To explore the application of CHA₂DS₂-VASc score in perioperative stratified anticoagulation for elderly hip fracture patients with non-valvular atrial fibrillation (NVAF). Methods A total of 78 elderly hip fracture patients with NVAF were enrolled. Age, gender, diabetes mellitus, hypertension, heart failure, stroke and vascular disease history were scored according to the preoperative CHA₂DS₂-VASc score, and the patients were divided into 3 groups:low-risk group (CHA₂DS₂-VASc score ≤ 1, 18 cases), medium-risk group (CHA₂DS₂-VASc score >1-2, 36 cases), and high-risk group (CHA₂DS₂-VASc score>2, 24 cases). Three groups were all switched to low molecular heparin for bridging anticoagulation 5 days before operation, and treated with aspirin, rivaroxaban and low molecular heparin for stratified anticoagulation 24-48 h after operation. The general clinical data, intraoperative blood loss, postoperative drainage and hemoglobin, perioperative international normalized ratio (INR), incidence of complications in 1 year after operation and the elderly hip fracture functional recovery scale (FRS) score were compared among the 3 groups. Results The CHA₂DS₂-VASc scores of patients in the low-, medium- and high-risk groups were 0.56±0.48, 1.73±0.23 and 5.62±0.76, respectively, showing significant differences (P<0.01). There was no significant difference in gender among the 3 groups (P=0.506). There was significant difference in age among the 3 groups (P<0.01), with patients in the low-risk group being the youngest and those in the high-risk group being the oldest. Compared with the low-risk group, the proportions of patients with previous diabetes mellitus, hypertension, congestive heart failure, ischemic stroke or transient ischemic attack (TIA), and vascular disease were significantly higher in the medium- and high-risk groups (all P<0.05); the proportion of patients with previous ischemic stroke or TIA was significantly higher in the high-risk group than in the medium-risk group (P=0.031); there were no significant differences in the proportions of patients with previous heart failure, hypertension, diabetes mellitus or cardiovascular disease between the medium- and high-risk groups (all P>0.05). There were no significant differences in operation time, intraoperative blood loss, postoperative drainage, hemoglobin levels or INR before, 1 d after, and 3 d after operation among the 3 groups, and the same was true for the incidences of ischemic/hemorrhagic stroke, acute coronary syndrome, deep vein thrombosis, and FRS scores 1 year after operation (all P>0.05). There were no deaths among the 3 groups. Conclusion The CHA₂DS₂-VASc score can guide the use of perioperative stratified anticoagulants in elderly hip fracture patients with NVAF according to the risk factors of thrombosis.