Background
Data on effectiveness and safety for Factor-Xa non-vitamin-K oral anticoagulants (NOACs) for patients with non-valvular atrial fibrillation and diabetes in the real-world setting is limited. We aimed to compare the risk of effectiveness and safety outcomes of individual NOACs vs. phenprocoumon in Germany.
Methods
We conducted a new user cohort study in patients with non-valvular atrial fibrillation based on German claims data between January 1st, 2013 and June 30th, 2017. A multiple Cox-regression was performed to calculate confounder-adjusted hazard ratios (HRs) for the risk of ischemic stroke/systemic embolism (IS/SE), intracranial haemorrhage (ICH), fatal bleeding, end stage renal disease and acute kidney injury in new users of NOACs (rivaroxaban, apixaban and edoxaban) vs. new users of phenprocoumon. 
Results
The population with NVAF and diabetes comprised 6,997 initiators of rivaroxaban, 5,438 of apixaban, 865 in of edoxaban and 8,545 of phenprocoumon. In the confounder-adjusted analysis, a comparable risk of IS/SE was observed for each NOAC compared to phenprocoumon with a trend towards better effectiveness for rivaroxaban (Table 1). For the risk of ICH, we observed a numerical benefit for NOACs over phenprocoumon and statistically significant risk reductions related to end stage renal disease for rivaroxaban (68%) and apixaban (40%). For the risk of acute kidney injury, only rivaroxaban showed a risk reduction (28%).
Conclusion
Our study adds evidence for a NOACs vs. VKA in a diabetes population. Moreover, it indicates a beneficial effect of NOACs on renal function worsening over time when compared to phenprocoumon. Further studies are warranted to consolidate these findings.

COMPARATIVE SAFETY AND EFFECTIVENESS OF NON-VITAMIN-K ORAL ANTICOAGULANTS VS PHENPROCOUMON IN PATIENTS WITH NON-VALVULAR ATRIAL FIBRILLATION AND DIABETES - RESULTS FROM THE RELOADED STUDY