Objective: We did a retrospective cohort study of patients who were diagnosed with AF or atrial flutter and on dialysis in Wonju Severance Christian Hospital. We collected medical records from 2010 to 2020. Methods: Among the 99 patients who were diagnosed with AF and on dialysis, 36 received anticoagulation (17 had warfarin, and 19 had apixaban 2.5 mg twice a day), while 63 received no anticoagulation. No significant difference in baseline characteristics was noted between patients with anticoagulation and those with no anticoagulation. Although the no anticoagulation group experienced more all-cause (39.7% vs. 32.4%, p = 0.572) and cardiovascular (17.6% vs. 10.8%, p = 0.197) mortality than the anticoagulation group, the difference was not statistically significant. Compared with patients with warfarin, those with apixaban 2.5 mg twice a day exposure experienced more frequent major adverse cerebrovascular events (hazard ratio, 15.74; 95% confidence interval, 1.24–200.72), but the difference was not statistically significant in the multivariate Cox regression analysis (hazard ratio, 2.80; 95% confidence interval, 0.34–23.02). Results: Anticoagulation group showed a higher risk of bleeding than no anticoagulation group and there was no significant difference in all-cause mortality between two groups. Apixaban 2.5mg twice a day was not inferior to warfarin considering the risk and benefit of anticoagulation in patients on dialysis except for the cerebrovascular risk. To sum up, we could not recommend low-dose apixaban for anticoagulation in patients with ESRD, and further large studies are needed. Conclusions: Objective: Atrial fibrillation (AF) is common supraventricular arrhythmia in patients with dialysis. Although the need for anticoagulation in patients with AF is high, there is still controversy about the efficacy of anticoagulation in patients with end-stage renal disease(ESRD). We aimed to compare the risk and benefit between the low-dose apixaban (2.5 mg twice a day) group and the warfarin group among the patients with AF and on dialysis. Methods: We did a retrospective cohort study of patients who were diagnosed with AF or atrial flutter and on dialysis in Wonju Severance Christian Hospital. We collected medical records from 2010 to 2020. Results: Among the 99 patients who were diagnosed with AF and on dialysis, 36 received anticoagulation (17 had warfarin, and 19 had apixaban 2.5 mg twice a day), while 63 received no anticoagulation. No significant difference in baseline characteristics was noted between patients with anticoagulation and those with no anticoagulation. Although the no anticoagulation group experienced more all-cause (39.7% vs. 32.4%, p = 0.572) and cardiovascular (17.6% vs. 10.8%, p = 0.197) mortality than the anticoagulation group, the difference was not statistically significant. Compared with patients with warfarin, those with apixaban 2.5 mg twice a day exposure experienced more frequent major adverse cerebrovascular events (hazard ratio, 15.74; 95% confidence interval, 1.24–200.72), but the difference was not statistically significant in the multivariate Cox regression analysis (hazard ratio, 2.80; 95% confidence interval, 0.34–23.02). Conclusions: Anticoagulation group showed a higher risk of bleeding than no anticoagulation group and there was no significant difference in all-cause mortality between two groups. Apixaban 2.5mg twice a day was not inferior to warfarin considering the risk and benefit of anticoagulation in patients on dialysis except for the cerebrovascular risk. To sum up, we could not recommend low-dose apixaban for anticoagulation in patients with ESRD, and further large studies are needed.