Warfarin, for many years, was the only oral anticoagulant available on the market for the prevention of stroke in patients with atrial fibrillation. Despite being safe and effective, warfarin's medication and food interactions, along with its requirement for frequent monitoring, make it less ideal in some patient populations. More recently, non-vitamin K oral antagonists (NOACs) have emerged as an appealing option as they have fewer medication interactions, do not have food interactions and do not require frequent monitoring. However, patients with a creatinine clearance (CrCl) of less than 30 mL/min were excluded in original drug trials for these agents. Leaving providers without certainty that these agents can be used safely and effectively in patients with renal dysfunction. This review article will summarize the current available data on the use of NOACs for the prevention of stroke in atrial fibrillation patients with renal dysfunction.