One meta- elevated risk of stroke in females with AF, with the risk appearing greatest for females 75 years Recent studies have suggested that female sex, in the absence of other AF risk fac- -VASc score of 0 in males and 1 in females), carries a low stroke risk that is similar to males. The excess risk for females was espe- cially evident among those with 2 non sex- related stroke risk factors; thus, female sex is a risk modifier and is age dependent.S4.1.1-49 Adding female sex to the CHA2 -VASc score matters for age >65 years or 2 non sex-related stroke 13. Patients with end-stage CKD who receive dialy- sis have increased prevalence of AF and other associated risk factors for strokeS4.1.1-50 and have increased bleeding risk.S4.1.1-50 S4.1.1-52 Warfarin, when studied in large retrospective studies, has been shown to offer protection from cardiovas- cular events without increasing bleeding;S4.1.1-29 however, in a recent meta-analysis, warfarin did not offer reduction in deaths, ischemic events, or strokes but increased the incidence of major Limited data exist on single- and multiple- dose apixaban (2.5 mg or 5 mg) in patients with AF and CKD on dialysis compared to healthy Patients with CKD on di- alysis accumulate apixaban (increase in apixaban area-under-the-plasma-concentration-versus- time-curve and trough drug levels), and apixaban 2.5 mg twice daily resulted in steady-state drug exposure comparable to 5 mg twice daily in pa- tients with preserved renal function. Dialysis had a limited impact on apixaban clearance. Bleed- ing complications were decreased. A recent trial compared apixaban (5 mg versus 2.5 mg twice daily) and warfarin in dialysis-dependent patients with AF. Patients receiving standard-dose apixa- ban (5 mg) had a lower risk of stroke/embolism than those receiving low-dose apixaban (2.5 mg) and warfarin. 