Vitamin K AntagonISt, Factor Xa Inhibitor or No Anticoagulation in Atrial Fibrillation and DIalytic End-stage Renal DiseasE (VISIONAIRE)

This trial (VISIONAIRE) is comparing three approaches to preventing strokes in patients with both atrial fibrillation and severe kidney disease (end-stage renal disease): a vitamin K antagonist, a factor Xa inhibitor, or no anticoagulation. **You may be eligible if...** - You have confirmed atrial fibrillation or flutter (paroxysmal, persistent, or permanent) - Your stroke risk score (CHA2DS2-VASc) is 2 or higher (3 or higher if female) - You have severe kidney disease (eGFR ≤15 or on dialysis) **You may NOT be eligible if...** - You are actively bleeding or had a serious bleed within the past month - You have had a prior kidney transplant - You have a mechanical heart valve or significant mitral valve narrowing - You have had a prior bleed inside the skull - You have severe liver disease (Child-Pugh class C) - You are pregnant or breastfeeding - You have another reason requiring blood thinners (e.g., recent blood clots) - Your platelet count is very low (below 50,000/mm³) Talk to your doctor to see if this trial is right for you.