Can Eliquis cause mental confusion? Understanding the connection
For those prescribed Eliquis (apixaban) to prevent blood clots from conditions like atrial fibrillation, deep vein thrombosis, or pulmonary embolism, understanding its potential side effects is crucial. While mental confusion is not a common side effect, its potential appearance is a significant medical concern, primarily because it can signal a serious, life-threatening bleeding event. A brain hemorrhage, while rare, is a known complication of anticoagulants, and symptoms can include confusion, dizziness, and severe headache. It is vital to recognize when these symptoms may indicate a medical emergency requiring immediate attention.
Potential neurological side effects
The primary mechanism through which Eliquis and other blood thinners can induce mental confusion is by causing bleeding in the brain. The medication's purpose is to prevent clots, but this increased bleeding risk applies to all parts of the body, including the delicate tissues of the brain. An intracranial hemorrhage can be devastating, leading to a range of neurological symptoms depending on the location and severity of the bleed.
Symptoms of a brain bleed can develop shortly after a head injury or appear gradually over time, especially in chronic subdural hematomas. Other reported neurological side effects, though less common, can also occur independently of a major bleed. Case reports, such as one involving an 80-year-old woman, have documented reversible neurological effects, including confusion and disorientation, which resolved after discontinuing apixaban. This suggests that in some sensitive individuals, a direct neurological effect of the drug, possibly exacerbated by high plasma concentrations or other risk factors like age and renal function, may contribute to symptoms.
Potential causes of confusion on Eliquis:
- Intracranial Hemorrhage: A rare but dangerous side effect where bleeding occurs in the brain, causing sudden-onset or gradual confusion, severe headache, vision changes, and dizziness.
- Anemia: Eliquis can cause bleeding, which over time can lead to anemia. Severe anemia can reduce oxygen delivery to the brain and cause symptoms like fatigue, dizziness, and, in some cases, mental fogginess or confusion.
- Overdosing/High Drug Concentration: In some cases, particularly in older adults or those with impaired kidney function, the concentration of Eliquis in the blood can become excessively high, potentially leading to neurological side effects.
- Drug Interactions: Combining Eliquis with certain other medications, such as some antifungal drugs or strong inhibitors of certain liver enzymes, can increase its blood concentration and thus heighten the risk of side effects, including bleeding and cognitive issues.
When to seek immediate medical attention
If mental confusion appears suddenly or is accompanied by other severe symptoms, it should be treated as a medical emergency. Do not wait for symptoms to resolve on their own. Seek emergency care immediately if you or someone you know experiences any of the following:
- Sudden, severe headache
- Loss of consciousness or fainting
- Numbness or weakness of the face, arm, or leg
- Vomiting blood or material that looks like coffee grounds
- Blood in the urine or stool
- Unusual bruising or bleeding that does not stop
Comparing Eliquis with other anticoagulants
Choosing an appropriate anticoagulant involves weighing the benefits of stroke prevention against the risks of bleeding and other side effects. When considering cognitive side effects, a comparison can be helpful. Both Eliquis and Xarelto are Direct Oral Anticoagulants (DOACs), while Warfarin is an older Vitamin K Antagonist.
| Feature | Eliquis (Apixaban) | Xarelto (Rivaroxaban) | Warfarin (Coumadin) |
|---|---|---|---|
| Mechanism | Factor Xa inhibitor | Factor Xa inhibitor | Vitamin K antagonist |
| Dosing | Twice daily | Once daily (mostly) | Highly variable, regular INR testing required |
| Major Bleeding Risk | Lower than Xarelto and Warfarin in multiple studies | Higher than Eliquis in comparative studies | Higher than DOACs, sensitive to dietary changes |
| Reported Cognitive Effects | Rare reports, often linked to bleeding | Rare reports, possibly linked to mitochondrial effects in some cases | Some studies show lower dementia rates than other anticoagulants, others conflicting results |
| Elderly Concerns | No increased age-related bleeding risk reported, but monitor for high drug levels | Increased bleeding risk in older adults reported in studies | Higher bleeding risk in older adults; careful monitoring needed |
Managing and mitigating cognitive side effects
If you experience potential cognitive side effects while on Eliquis, the first and most critical step is to report them to your healthcare provider. Your doctor can evaluate the situation to determine if a serious bleeding event is the cause. Depending on the diagnosis, they may adjust your dosage, switch to a different anticoagulant, or pursue other avenues of investigation.
For neurological symptoms not related to a major bleed, alternative blood thinners or lifestyle adjustments may be recommended. Never stop taking Eliquis on your own without consulting a doctor, as doing so can dangerously increase your risk of a blood clot or stroke. In general, managing potential side effects involves close monitoring and a proactive dialogue with your medical team. For those interested in alternatives, resources like Marley Drug provide detailed comparisons and options, such as Pradaxa or Savaysa, which may have different side effect profiles.
Conclusion
While the primary benefit of Eliquis is preventing dangerous blood clots, it is essential to be aware of all potential side effects, including the rare possibility of mental confusion. The most serious concern is that mental changes could signify a potentially life-threatening brain bleed, requiring immediate emergency medical attention. Less commonly, confusion may be a direct, though reversible, neurological effect of the drug. Patients should maintain open communication with their doctors, report any unusual symptoms promptly, and never discontinue the medication without medical guidance. By being informed and vigilant, patients can manage the risks and maximize the therapeutic benefits of Eliquis safely.
