Objective To explore efficacy and therapeutic effect of different anticoagulant regimens in the elderly patients with pulmonary embolism. Methods A total of 70 consecutive elderly patients with pulmonary embolism admitted in our hospital from January 2010 to July 2015 were enrolled in the study. All of them received anticoagulation therapy with warfarin and low molecular weight heparin. According to whether obtaining the target value of international normalized ratio (INR), they were divided into high-anticoagulation group (n=23, INR>2.5) and low-anticoagulation group (n=47, INR ≤2.5). The warfarin dose adjustment, anticoagulation efficacy and therapeutic effects were compared between the 2 groups. The data were analyzed with SPSS statistics 19.0. Continuous data were expressed as mean±standard deviation after checking for normality of distribution, and Student’s t test was used for group comparison. The data not normally distributed were expressed with median and interquartile range, and intergroup comparison was conducted by Mann-Whitney U test. Enumeration data were expressed as percentage, and intergroup comparison was carried out with Chi-square test or Fisher exact test. Results Dyspnea (68.6%) and pulmonary hypertension (60.0%) were the main manifestations in the 70 patients. Compared with the low-anticoagulation group, the high-anticoagulation group had significantly increased target value of INR level [(2.94±0.33) vs (1.95±0.33), P<0.001], obviously decreased dosage of warfarin after adjustment [(1.61±0.51) vs (2.33±0.54)mg, P<0.001], and more common discontinuation and dose adjustment of warfarin (52.2% vs 12.8%, P<0.001). Meanwhile, there was no significant difference in clinical efficacy and incidences of bleeding events and gastrointestinal symptoms between the 2 groups (P>0.05). Conclusion For maintenance of anticoagulation therapy in the elderly with pulmonary embolism, low-anticoagulation regimen shows similar clinical efficacy as high dose, and it also can significantly decrease the incidence of discontinuation and dose adjustment of warfarin during the process.