Winkelmayer et al. report, using a propensity-matched USRDS 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[1]. These results extend prior evidence[2], yet several issues deserve clarification.