Use of the novel oral anticoagulants dabigatran and rivaroxaban is contraindicated in patients undergoing dialysis because the drugs can bioaccumulate and cause increased bleeding. Dabigatran and rivaroxaban prescription rates were surveyed in 29,977 dialysis patients with atrial fibrillation (AF), and rates of bleeding and death from bleeding were compared in dialysis patients taking warfarin, dabigatran, or rivaroxaban. Investigators involved in the study reported that the use of dabigatran and rivaroxaban in haemodialysis patients has steadily increased since the drugs first became available in the USA. Importantly, a covariate regression analysis showed that dabigatran (rate ratio [RR] 1.48, 95% CI 1.21–1.81, P = 0.0001) and rivaroxaban (RR 1.38, 95% CI 1.03–1.83, P = 0.04) were associated with an increased risk of hospitalization or death from bleeding compared with warfarin. Additional studies to assess the safety and efficacy of these agents in dialysis patients are required before they can be recommended.