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Antithrombotic agents may reduce symptoms in severe mental illness, but evidence is very low certaintyBlood-thinning drugs show possible benefit for severe mental illness symptoms

AI-generated summary of the cited source, checked by automated accuracy review. How we work

Key Takeaway
Interpret very low-certainty evidence on antithrombotics for SMI with extreme caution.

A systematic review and meta-analysis examined the effects of antithrombotic agents (aspirin, cilostazol, dipyridamole) versus placebo in 742 patients with severe mental illness, including schizophrenia, major depression, and bipolar disorder. The primary outcomes were symptom severity, risk of recurrence, and tolerability.

For depressive symptoms, treatment with antithrombotic agents was associated with a reduction, with a standardized mean difference (SMD) of -0.62 (95% CI -1.11 to -0.13). For the PANSS total score, a reduction was also observed, with an SMD of -0.57 (95% CI -0.86 to -0.28). Absolute numbers for these outcomes were not reported. Tolerability, based on very low-certainty evidence from 9 studies, may not differ from placebo (risk ratio 0.89; 95% CI 0.57-1.40). Data on specific adverse events, serious adverse events, and discontinuations were not reported.

Key limitations include the very low-certainty of the evidence (per GRADE framework), meaning effect estimates should be interpreted with caution and the therapeutic potential of these agents in severe mental illness remains uncertain. The study setting and follow-up duration were not reported. In practice, these findings are hypothesis-generating. Well-powered randomized controlled trials investigating clinically relevant outcomes in clearly defined populations are needed before any clinical application can be considered.

Researchers reviewed existing studies to see if blood-thinning medications, called antithrombotic agents, could help people with severe mental illnesses like schizophrenia, major depression, and bipolar disorder. They combined data from several small trials involving 742 patients total. The medications studied included common drugs like aspirin, cilostazol, and dipyridamole.

The analysis suggested these medications might slightly reduce symptoms of depression and overall schizophrenia symptoms compared to a placebo. The drugs also appeared to be tolerated about as well as a placebo, meaning side effects might not be worse. However, the researchers rated all this evidence as being of 'very low certainty'.

This means we cannot be confident in these results. The findings are based on a small number of patients and studies that may have had flaws. The researchers strongly state that the potential benefit of these drugs for mental illness remains very uncertain. More and better research is needed before anyone could consider this a treatment option. For now, this is an early, uncertain signal that requires much more investigation.

What this means for you:
Early, very weak evidence suggests blood thinners might help mental illness symptoms, but much more research is needed.

Study Details

Study typeMeta analysis
Sample sizen = 742
EvidenceLevel 1
PublishedApr 2026
View Original Abstract ↓
Evidence suggests shared pathophysiologic mechanisms between severe mental illness (SMI) and cardiovascular disease (CVD). Drugs used for CVD, such as antithrombotic agents (ATAs), may therefore be repurposed for the treatment of SMI. We conducted the first systematic review and meta-analysis (PROSPERO registration CRD42024524420) of ATAs for SMI and reported results according to PRISMA guidelines. We searched MEDLINE, Embase, and PsycINFO (October 10, 2024) and performed random-effects meta-analysis. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool, and the certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework. Primary outcomes were symptom severity, risk of recurrence, and tolerability. We included 12 randomized trials investigating aspirin, cilostazol, and dipyridamole in a total of 742 patients with schizophrenia, major depression, and bipolar disorder. Results showed that ATA treatment may reduce depressive symptoms in patients with SMI (SMD -0.62; 95 % CI -1.11 to -0.13; 8 studies; very low-certainty evidence). Based on studies with low risk of bias, ATA treatment may reduce PANSS total score compared with placebo (SMD -0.57; 95 % CI -0.86 to -0.28; 3 studies; very low-certainty evidence). Tolerability of ATAs may not differ from placebo (RR 0.89; 95 % CI 0.57-1.40; 9 studies; very low-certainty evidence). Given the low certainty of the evidence, effect estimates should be interpreted with caution. The therapeutic potential of ATAs in SMI remains uncertain. Well-powered RCTs investigating clinically relevant outcomes in clearly defined populations are needed.
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