Anticoagulation therapy plays a crucial role in managing patients with atrial fibrillation (AF) undergoing chronic haemodialysis, particularly for preventing thromboembolic events during the procedure. Purpose of our study was to compare the effectiveness and safety of direct oral anticoagulants (DOAC, apixaban) versus vitamin K antagonist (VKA, warfarin) in patients with atrial fibrillation on chronic haemodialysis. Patients on dialysis who had initiated treatment with an oral anticoagulant between 2020 and 2024 were eligible for inclusion. The primary safety and effectiveness outcome was the occurrence of major bleeding events and thrombotic events. We compared the safety and effectiveness outcomes for DOAC and VKA using propensity-score-weighted cause-specific Cox regression. 189 patients received an oral anticoagulant (56 DOAC and 133 VKA) for the first time after the initiation of dialysis. Over a median [interquartile range] follow-up period of 2.8 [1.7-3.8] years, 35 patients presented a first thromboembolic event and 16 patients had a bleeding event. After propensity score adjustment, the risk of a thromboembolic event was significantly lower in patients treated with a DOAC than in patients treated with a VKA (weighted hazard ratio (HR) [95% confidence interval (CI)]: 0.69 [0.54; 0.95]. A non-significant trend toward lower risk of major bleeding events was found in patients treated with a DOAC compared to patients treated with a VKA (weighted HR [95% CI]: 0.71 [0.51; 1.16]) (Fig.1.). Sensitivity analyses showed the same trends. Our study of patients with AF on dialysis have assessed the effectiveness and safety of DOAC prescription relative to VKA prescription. In a small group of dialysis patients initiating oral anticoagulation, the use of DOACs was associated with a statistically significant lower risk of thromboembolic events, and a non-significant lower risk of bleeding relative to VKA use.