Heparin-induced thrombocytopenia (HIT) is a prothrombotic condition caused by antibodies against the heparin-PF4 complex. This disorder is even more problematic in patients undergoing hemodialysis since they are repeatedly exposed to heparin. The diagnostic and therapeutic approach is particularly challenging in this population. We report the case of a woman with chronic kidney disease and a high pretest probability for heparin-induced thrombocytopenia who was acutely treated with apixaban, an oral selective factor Xa inhibitor.