Reversible Neurological Adverse Reaction to Apixaban

• Main Authors: Eduardo Rodrigues Cernadas, Catarina Dionisio, Dalia Estevão, Leopoldina Vicente
• Format: Article
• Language: English
• Published: SMC MEDIA SRL 2021-04-01
• Series: European Journal of Case Reports in Internal Medicine
• Subjects: apixaban; neurological symptoms; adverse drug reaction
• Online Access: https://www.ejcrim.com/index.php/EJCRIM/article/view/1739

Prescriptions for the novel oral anticoagulant factor Xa inhibitors (rivaroxaban, apixaban, edoxaban) have equalled or exceeded those for vitamin K antagonists in many clinical settings requiring chronic anticoagulation, and those of injectable heparins for deep vein thrombosis prophylaxis. The authors report the case of an 80-year-old woman followed by her cardiologist for permanent atrial fibrillation who was prescribed apixaban. Within a few days the patient developed neurological symptoms of imbalance and non-vertiginous dizziness, headache, confusion/disorientation and asthenia. Her symptoms began to resolve after the drug was stopped, with return to baseline function within 72 h. The plasma concentration of apixaban was 4 times higher than the laboratory upper limit of normal. Symptoms did not recur when the patient was switched to rivaroxaban therapy.