Atrial fibrillation (AF) affects 21% of patients with kidney failure undergoing hemodialysis (HD).1 AF is associated with 2-fold higher adjusted risk of ischemic stroke and 9 times higher adjusted mortality risk during the first 30 days after AF diagnosis in the HD population.2 In 2012 the US Food and Drug Administration (FDA) approved apixaban for AF in patients with creatinine clearance≥25mL/min. This was subsequently amended to include patients on maintenance HD with a dose reduction indicated by age≥80 years or weight≤60kg.