PMID- 33685912
OWN - NLM
STAT- MEDLINE
DCOM- 20210514
LR  - 20231031
IS  - 1757-790X (Electronic)
IS  - 1757-790X (Linking)
VI  - 14
IP  - 3
DP  - 2021 Mar 8
TI  - Treatment with the direct oral anticoagulants (DOACs) apixaban and rivaroxaban 
      associated with significant worsening of behavioural and psychological symptoms 
      of dementia (BPSD).
LID - 10.1136/bcr-2020-240059 [doi]
LID - e240059
AB  - We report the cases of two patients who developed worsening behavioural and 
      psychological symptoms of dementia (BPSD), coinciding with starting the factor Xa 
      inhibitor direct oral anticoagulant medications apixaban and rivaroxaban, 
      respectively. Both patients required detaining under the Mental Health Act. Their 
      symptoms improved significantly, within 2 weeks, on switching to alternative 
      anticoagulant therapies and they were both discharged from the acute psychiatric 
      ward. Front-line staff should partake in postmarketing surveillance of 
      medications, completing the Medicines and Healthcare products Regulatory Agency 
      yellow cards for example (UK). There is increasing evidence for an aetiological 
      role of cerebral mitochondrial dysfunction in neuropsychiatric disorders. 
      Development of a rating scale of drugs that are potentially less toxic to 
      cerebral mitochondria could inform national prescribing guidelines and enable 
      safer treatments to be offered to older people, reducing the likely hood of them 
      experiencing apparent BPSD.
CI  - (c) BMJ Publishing Group Limited 2021. Re-use permitted under CC BY-NC. No 
      commercial re-use. See rights and permissions. Published by BMJ.
FAU - Porter, Kim Maria Frances
AU  - Porter KMF
AD  - Older Peoples Community Mental Health Team, Somerset NHS Foundation Trust, Frome, 
      Somerset, UK.
FAU - Hargreaves, Iain Parry
AU  - Hargreaves IP
AD  - Department of Molecular Neuroscience, UCL Queen Square Institute of Neurology, 
      National Hospital, London, UK i.hargreaves@ucl.ac.uk.
FAU - De Souza, Stephen
AU  - De Souza S
AD  - Older Peoples Psychiatric Inpatient Unit, Somerset NHS Foundation Trust, Taunton, 
      Somerset, UK.
FAU - Goddard, Rebecca
AU  - Goddard R
AD  - Complex Treatment and Intervention Team, Avon and Wiltshire Mental Health 
      Partnership NHS Trust, Midsomer Norton, Somerset, UK.
LA  - eng
PT  - Case Reports
PT  - Journal Article
DEP - 20210308
PL  - England
TA  - BMJ Case Rep
JT  - BMJ case reports
JID - 101526291
RN  - 0 (Anticoagulants)
RN  - 0 (Pyrazoles)
RN  - 0 (Pyridones)
RN  - 3Z9Y7UWC1J (apixaban)
RN  - 9NDF7JZ4M3 (Rivaroxaban)
RN  - I0VM4M70GC (Dabigatran)
SB  - IM
MH  - Administration, Oral
MH  - Aged
MH  - Aged, 80 and over
MH  - Anticoagulants/adverse effects
MH  - Dabigatran
MH  - *Dementia/chemically induced/drug therapy
MH  - Humans
MH  - Pyrazoles
MH  - Pyridones/adverse effects
MH  - *Rivaroxaban/adverse effects
PMC - PMC7942237
OTO - NOTNLM
OT  - drugs: CNS (not psychiatric)
OT  - memory disorders (psychiatry)
OT  - psychiatry (drugs and medicines)
OT  - psychiatry of old age
OT  - unwanted effects / adverse reactions
COIS- Competing interests: None declared.
EDAT- 2021/03/10 06:00
MHDA- 2021/05/15 06:00
PMCR- 2021/03/08
CRDT- 2021/03/09 06:01
PHST- 2021/03/09 06:01 [entrez]
PHST- 2021/03/10 06:00 [pubmed]
PHST- 2021/05/15 06:00 [medline]
PHST- 2021/03/08 00:00 [pmc-release]
AID - 14/3/e240059 [pii]
AID - bcr-2020-240059 [pii]
AID - 10.1136/bcr-2020-240059 [doi]
PST - epublish
SO  - BMJ Case Rep. 2021 Mar 8;14(3):e240059. doi: 10.1136/bcr-2020-240059.