Can Apixaban Make You Confused? Understanding the Risks

October 10, 2025 •

4 min read

Confusion is listed as a rare side effect of apixaban. While uncommon, reports confirm that can apixaban make you confused, but this symptom sometimes indicates a serious underlying complication such as intracranial bleeding, which necessitates immediate medical attention.

Quick Summary

Reports indicate confusion can occur while on apixaban, potentially pointing to a serious medical event like internal or brain bleeding. Immediate medical evaluation is crucial if symptoms arise, especially alongside other neurological signs.

Key Points

Rare Side Effect: Confusion is listed as a rare adverse effect of apixaban.
Sign of Serious Bleeding: Sudden or severe confusion can indicate a major bleeding event, particularly in the brain, and requires immediate medical attention.
Other Contributing Factors: Anemia, drug interactions, advanced age, and impaired kidney function can also lead to confusion while on apixaban.
Do Not Stop Abruptly: Stopping apixaban without medical supervision increases the risk of stroke or blood clots.
DOACs vs. Warfarin: Studies indicate that apixaban and other DOACs may carry a lower risk of major bleeding, including intracranial hemorrhage, and may be associated with a lower risk of new-onset dementia compared to warfarin.
Consult Your Doctor: Promptly report any new or worsening confusion to your healthcare provider for evaluation to determine the cause and manage the risk appropriately.

Apixaban and the Potential for Confusion

Apixaban, commonly known by the brand name Eliquis, is a direct oral anticoagulant (DOAC) prescribed to prevent dangerous blood clots. It is widely used for conditions like atrial fibrillation and for preventing deep vein thrombosis (DVT) and pulmonary embolism (PE). While effective, like all medications, it carries a risk of side effects. Confusion, along with decreased alertness, is listed as a rare adverse effect. Several factors can contribute to this symptom, ranging from direct drug effects to severe bleeding complications. Understanding the potential causes and knowing when to seek urgent medical care is critical for patient safety.

When Confusion Signals a Serious Problem

The most significant and life-threatening cause of confusion associated with apixaban is a major bleeding event, particularly bleeding in the brain (intracranial hemorrhage). Apixaban's blood-thinning properties can increase the risk of bleeding, and if bleeding occurs in the central nervous system, it can cause severe neurological symptoms, including confusion. It is crucial to be aware of the signs of a severe bleed, as this requires immediate emergency medical attention.

Symptoms of serious bleeding in the brain include:

Sudden, severe headache
Confusion, dizziness, or decreased alertness
Slurred speech or difficulty speaking
Numbness or weakness on one side of the face, arm, or leg
Vision changes
Vomiting

Other Factors That May Contribute to Confusion

While intracranial bleeding is a grave concern, other issues related to apixaban use can also lead to confusion or cognitive impairment. These are important to consider with a healthcare provider to determine the root cause of the symptoms.

Anemia: Apixaban can cause bleeding, which over time can lead to anemia (low red blood cell count). Symptoms of anemia, such as fatigue, dizziness, and a rapid heartbeat, can mimic or exacerbate feelings of confusion or fogginess.
Drug Interactions: Certain medications can affect how apixaban is metabolized in the body, leading to increased or decreased drug levels. For instance, drugs that strongly inhibit the CYP3A4 enzyme or the P-glycoprotein transporter can increase apixaban concentrations and raise the risk of bleeding. A high concentration of the drug may induce neurological side effects.
Age and Kidney Function: Case reports have described reversible neurological symptoms, including confusion, in elderly patients with chronic renal failure who were prescribed apixaban. Advanced age and impaired kidney function can both affect drug clearance, potentially leading to higher drug levels and an increased risk of adverse effects.
Individual Sensitivity: As with any medication, some individuals may have a unique sensitivity to apixaban, leading to neurological side effects even without a clear bleeding event. A case report in the National Institutes of Health (NIH) documents a woman who experienced reversible neurological symptoms, including confusion and disorientation, which resolved upon discontinuation of apixaban and recurred upon re-challenge.

Apixaban vs. Warfarin: A Comparative Look at Cognitive Risk

For many years, warfarin was the standard anticoagulant. Apixaban is one of the newer direct oral anticoagulants (DOACs). Comparative studies have shed light on the differences in side effect profiles, including those related to cognitive function.


Feature	Apixaban (Eliquis)	Warfarin	Comments
Incidence of Confusion	Rare, can be a sign of serious bleed or other issue.	Infrequent, but major bleeding risk (including in brain) is higher.	For both, confusion is a red flag for serious bleeding.
Brain Bleed Risk	Lower risk of intracranial bleeding compared to warfarin.	Higher risk of intracranial hemorrhage.	This is a major advantage for DOACs.
Dementia Risk	Associated with a significantly lower risk of new-onset dementia in AF patients compared to warfarin.	Higher associated risk of dementia compared to DOACs.	Studies show an overall cognitive advantage for DOACs.
Drug-Food Interactions	Few food restrictions.	Significant food (e.g., Vitamin K) and drug interactions.	This simplifies patient management and reduces variability.
Dosing Schedule	Fixed dosing, typically twice daily.	Dosing requires frequent monitoring (INR) and adjustment.	Fixed dosing can reduce confusion risks related to complex regimens.

What to Do If You Experience Confusion on Apixaban

Because confusion while on apixaban can be a sign of a serious medical emergency like a brain bleed, it's imperative to take action swiftly.

Seek Medical Help Immediately: If confusion is sudden, severe, or accompanied by symptoms like a severe headache, vision changes, or numbness, call emergency services (e.g., 911) right away.
Contact Your Prescribing Physician: For less severe or gradual-onset confusion, contact your doctor as soon as possible. They can evaluate your symptoms, review your other medications, and potentially order tests to check for issues like anemia or impaired kidney function.
Do Not Stop Taking the Medication: Never stop taking apixaban abruptly without consulting your healthcare provider. Discontinuing the medication increases the risk of dangerous blood clots and stroke.
Communicate with Loved Ones: Inform family members or caregivers about your symptoms. They can help monitor your condition and assist in seeking medical care if needed.
Review Medication and Health Profile: Your doctor may review your entire medication list for potential interactions and check for other underlying health conditions contributing to the confusion.

Conclusion

While apixaban is a crucial medication for preventing strokes and blood clots, the risk of side effects, including rare but potentially serious ones like confusion, must be acknowledged. The most urgent concern is that confusion could be a warning sign of a severe internal bleed. Therefore, any new or worsening cognitive changes should be evaluated promptly by a healthcare professional. Unlike warfarin, apixaban is generally associated with a lower risk of serious bleeding and may have a favorable cognitive profile over the long term. However, this does not negate the importance of vigilant monitoring and proactive communication with your healthcare team to ensure the safe and effective use of this medication. For more detailed information on side effects, patients can also refer to the FDA's prescribing information.

This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

Frequently Asked Questions

No, confusion is considered a rare side effect of apixaban. It is not commonly reported, but its occurrence should be taken seriously as it can signal a more urgent medical issue.

If you experience sudden or severe confusion, especially with other symptoms like a headache, vision changes, or numbness, seek immediate emergency medical care. For less severe symptoms, contact your prescribing physician for an evaluation.

Yes, confusion can be a symptom of a stroke caused by bleeding in the brain (intracranial hemorrhage), a serious risk associated with all anticoagulants. The risk is lower with apixaban than with warfarin, but it remains a possibility that requires urgent medical attention.

While not as clearly defined as confusion, some patients report symptoms like 'brain fog' while on apixaban. This could be related to rare neurological effects, anemia, or other issues, and should be discussed with a healthcare provider.

Yes, some reports suggest that older adults, particularly those with reduced kidney function, may have a higher likelihood of experiencing dizziness and confusion on apixaban. This is likely due to slower drug clearance, which can lead to higher blood concentrations.

No, you should never stop taking apixaban without consulting your doctor. Suddenly stopping the medication significantly increases your risk of forming blood clots and suffering a stroke.

Studies comparing apixaban and other DOACs to warfarin have shown that DOACs are associated with a significantly lower risk of new-onset dementia in patients with atrial fibrillation.