Winkelmayer et al1 report, using a propensity-matched US Renal Data System cohort, that apixaban initiation in hemodialysis patients with newly diagnosed atrial fibrillation lowers ischemic stroke and a composite thromboembolic endpoint, while reducing all-cause mortality (HR 0.61), at the cost of higher hemorrhagic stroke and clinically important bleeding. These results extend prior evidence,2, yet several issues deserve clarification.