Does Apixaban Affect Memory? Separating Fact from Common Fears

October 11, 2025 •

4 min read

Large-scale studies have shown that patients with atrial fibrillation taking non-vitamin K oral anticoagulants (NOACs), including apixaban, have a significantly lower risk of developing new-onset dementia compared to those taking warfarin. This provides important context to the question, does apixaban affect memory?

Quick Summary

Clinical evidence suggests apixaban is associated with a lower dementia risk than warfarin. While rare neurological side effects like confusion are possible, the medication generally protects cognitive function by preventing strokes. Patients with concerns should discuss symptoms with their doctor.

Key Points

Lower Dementia Risk: Studies show apixaban is associated with a significantly lower risk of new-onset dementia compared to warfarin, particularly for patients with atrial fibrillation.
Rare Side Effects: While rare, neurological side effects like confusion and dizziness have been reported, primarily in older adults.
Stroke Prevention: The primary function of apixaban is to prevent blood clots and strokes, which are a major cause of cognitive decline and dementia.
Bleeding Risk: Any blood thinner carries a risk of bleeding, including intracranial hemorrhage, which can cause severe neurological symptoms. Apixaban has a lower intracranial bleeding risk than warfarin.
Underlying Conditions: Cognitive changes on anticoagulants may be related to the underlying condition (e.g., AFib) or other factors, not necessarily the medication itself.
Medical Evaluation is Key: If cognitive changes occur, it is crucial to speak with a healthcare provider to determine the cause and appropriate management.

Understanding the Connection Between Anticoagulation and Cognitive Health

For many patients, particularly those with conditions like atrial fibrillation (AFib), anticoagulants are a crucial component of care to prevent stroke. Atrial fibrillation increases the risk of stroke by allowing blood to pool in the heart, potentially forming clots that can travel to the brain. While apixaban's primary purpose is to inhibit this clotting process and prevent major strokes, its effect on long-term cognitive health is a subject of patient concern and clinical study. The question of whether apixaban impacts memory is best answered by considering both the protective effects of adequate anticoagulation and the very rare, reported instances of neurological adverse events.

Apixaban and the Reduced Risk of Dementia

Contrary to fears of memory impairment, much of the recent research points toward a positive, or at least protective, effect of modern anticoagulants on cognitive health. Observational studies comparing non-vitamin K antagonist oral anticoagulants (NOACs), such as apixaban, to traditional vitamin K antagonists (VKAs), like warfarin, have yielded significant findings. A meta-analysis published in 2023 found that apixaban was associated with a significantly lower risk of new-onset dementia compared to warfarin in patients with AFib. The potential mechanisms for this protective effect include:

Prevention of Silent Strokes: AFib can lead to both major strokes and smaller, asymptomatic strokes (also known as 'silent cerebral infarcts'). Over time, these small events can accumulate and contribute to cognitive decline. By providing effective anticoagulation, apixaban may prevent these micro-clots from causing brain damage.
Lower Intracranial Bleeding Risk: Compared to warfarin, apixaban and other DOACs have shown a significantly lower rate of intracranial hemorrhage (brain bleeds), a dangerous complication that can cause severe neurological damage.
Better-Managed Anticoagulation: Because DOACs like apixaban do not require the same intensive monitoring as warfarin, they provide a more stable level of anticoagulation, potentially reducing the risk of cognitive issues associated with subtherapeutic or poorly controlled INR levels.

Rare Neurological Adverse Effects

While the long-term data is reassuring, it is important to acknowledge that some rare neurological side effects have been reported. Some case reports have documented neurological symptoms, including confusion and dizziness, linked to apixaban and other DOACs, often in older adults. It is crucial to distinguish between correlation and causation in these instances. Reported symptoms often resolve upon discontinuation of the drug or adjustment of dosage. It is worth noting that confusion and dizziness can also be symptoms of a more serious event, such as a brain bleed, which is a known risk of all blood thinners. Patients experiencing sudden or concerning neurological symptoms should seek immediate medical attention.

Potential contributing factors to rare side effects:

High plasma concentration of the drug.
Underlying cerebral pathology or pre-existing cognitive impairment.
Drug interactions or polypharmacy.

Cognitive Concerns vs. Apixaban's Risks and Benefits

When considering the relationship between apixaban and memory, it's essential to weigh the potential risks and benefits. The risk of a major stroke, which has devastating cognitive consequences, is a far greater threat than the rare possibility of mild neurological side effects. The benefit of preventing strokes and possibly long-term dementia is substantial for many patients. For patients with underlying cognitive issues, clinicians must carefully consider the potential for worsening behavioral and psychological symptoms of dementia (BPSD), as highlighted in some case studies.

Management and Discussion with Your Healthcare Provider

If you have memory concerns while taking apixaban, it is important to discuss them with your doctor. They can evaluate whether your symptoms are related to the medication, your underlying medical condition (like AFib), or other factors. Never stop taking your anticoagulant without consulting your prescriber, as this can put you at high risk for a stroke.

Table: Apixaban vs. Warfarin for Cognitive Risk


Feature	Apixaban (DOAC)	Warfarin (VKA)
Mechanism	Direct Factor Xa inhibitor; more predictable action.	Vitamin K antagonist; affects multiple clotting factors, less predictable.
Monitoring	No routine blood monitoring required for efficacy.	Requires regular INR monitoring to ensure efficacy and safety.
Intracranial Bleeding Risk	Significantly lower risk compared to warfarin.	Higher risk of intracranial hemorrhage.
Dementia Risk (in AFib)	Associated with a significantly lower risk of new-onset dementia.	Historically linked to higher rates of dementia, especially if not well-managed.
Cognitive Concerns	Rare reported cases of confusion/dizziness, often in older adults; potentially linked to high drug levels or underlying conditions.	Cognitive issues can arise from poorly controlled INR, leading to micro-bleeds or strokes.

Conclusion

While it is a valid question to ask, does apixaban affect memory?, the evidence strongly suggests that for the majority of patients, the medication provides a significant protective effect against cognitive decline. By preventing strokes and having a lower risk of intracranial bleeding compared to older drugs like warfarin, apixaban helps preserve cognitive function in the long term. Rare neurological side effects, including confusion, have been reported but should be evaluated by a medical professional to rule out more serious issues, such as bleeding or complications from underlying conditions. Ultimately, the cognitive benefits of preventing stroke in at-risk patients typically outweigh the rare potential for adverse neurological events. It is essential for patients with concerns to have an open and honest conversation with their healthcare provider to ensure safe and effective treatment. For more information on anticoagulants and dementia risk in atrial fibrillation, refer to the study in the National Institutes of Health database.

Frequently Asked Questions

While rare, some reports indicate that Eliquis (apixaban) and other DOACs can cause neurological symptoms, including confusion and dizziness, especially in older adults. These symptoms should be promptly reported to a doctor, as they can also indicate a more serious issue like a bleed.

Yes, several large studies have shown that apixaban is associated with a significantly lower risk of new-onset dementia compared to warfarin, particularly in patients with atrial fibrillation.

Apixaban primarily helps prevent cognitive decline by lowering the risk of strokes, including both major and 'silent' cerebral infarcts, which can cause significant brain damage and contribute to dementia.

You should immediately contact your healthcare provider. Do not stop taking the medication on your own, as this can increase your risk of stroke. Your doctor will evaluate your symptoms to determine the cause and whether any treatment changes are necessary.

Yes, memory issues can stem from a variety of causes unrelated to apixaban, including the underlying medical condition (e.g., atrial fibrillation), other medications, or factors like high blood pressure, diabetes, or age.

By preventing the formation of blood clots that could cause strokes, apixaban protects brain tissue from damage. These clots can lead to both acute strokes and chronic, microscopic brain injuries that cause cognitive decline over time.

No. While all blood thinners carry a risk of bleeding that can impact the brain, modern DOACs like apixaban are generally associated with a better cognitive outcome and lower dementia risk compared to older agents like warfarin. Poorly controlled anticoagulation, rather than the drug itself, can be a risk factor for cognitive issues.