Trial to Evaluate Anticoagulation Therapy in Hemodialysis Patients With Atrial Fibrillation

Inclusion Criteria: * Males and females, age at least 18 years, or the local age of consent, whichever is greater. * Patients with AF defined as AF on ECG at enrollment or two or more reports of AF from separate monitoring events at least 2 weeks apart (report of ECG, Holter monitor, event monitor or implantable loop recorder). * CHA2DS2-VASc score of ≥ 2. * End-stage renal disease treated with hemodialysis for ≥ 3 months. * Considered by the treating physician(s) to be candidate for oral anticoagulation. * If of childbearing potential, be willing to avoid pregnancy during the study. Exclusion Criteria: * Not considered by the treating physician(s) to be candidates for oral anticoagulation (for example, hemoglobin \< 8.5g/dL, history of intracranial hemorrhage, active bleeding, recent gastrointestinal bleed or retroperitoneal bleed, severe hepatic impairment, or anaphylactic reaction to apixaban) * Moderate or severe mitral stenosis * Conditions other than AF that require anticoagulation such as mechanical prosthetic valve, deep venous thrombosis, or pulmonary embolism * Need for aspirin at a dose \> 81 mg a day or need for P2Y12 antagonist therapy (for example clopidogrel, prasugrel, or ticagrelor) * Life expectancy \< 3 months * Anticipated kidney transplant within the next 3 months * Prisoners or others who are involuntarily incarcerated or detained * Pregnant, breastfeeding, or considering pregnancy. * Participation in a clinical trial of an experimental treatment within the past 30 days