Coumadin and Nattokinase

[trinhsman]

My wife (age 40) recently suffered a minor brain stem stroke as a result of an injury to an artery in the back of her neck. Her doctor has put her on Coumadin. It has of course caused all kinds of problems. Her INR levels are stable at 2.5, but she is weak, dizzy, has stomach pains, and has had an occaisional bloody stool that goes away. She also has no stamina any more. Before her stroke and going on Coumadin she was doing aerobic exercise routines 3-5 times a week as well as working in a retail job on her feet all day. At this rate she will never be able to return to work or exercise again. We would like to wean her away from the Coumadin and replace it with Asperin and Nattokinase.

YOUR THOUGHTS.

There is NO family history of stroke. She is Asian, and has always had lower blood pressure (90/50-105/60)

Any help you can give will be appreciated:

trinhsman@aol.com

Ernie Adams
Jacksonville, Fl

[Health Dr. 2]

Hi Ernie:

The information below may be of some help to you:

Q1: "The subject of Nattokinase seems to have grown over the past year. Seems that a lot of folks are jumping off the coumadin band wagon to take Nattokinase (or Natto) as an anticoagulant. Do you have any knowledge of Nattokinase being a valid anticoagulant?"

A1: Nattokinase may have activity in preventing blood clots, but due to the lack of clinical studies (except for one of limited quality) it can not be concluded that it is a valid anticoagulant.

Q2: "Several people on the list at the factor V web site are using Nattokinase as a clot dissolver along with coumadin and may be tapering down to just Natto. The claim is that it enhances the body's natural ability to fight blood clots in several different ways. Because it so closely resembles plasmin, it dissolves fibrin directly. Do you have any opinions on this soy product?"

A2: While Nattokinase may have some potential to protect from blood clots, it has not been appropriately studied. Any comments and conclusions that "it is effective in preventing blood clots in humans" are, at present, speculation, and any claim that one should consider "using warfarin and Nattokinase together and titrate the warfarin downward" to "decrease the harmful effects of warfarin while maintaining a safer level of anticoagulation with the positive effects of nattokinase" are clinically and scientifically unsound. Nattokinase is not a substitute for warfarin. If an individual takes it, he/she should not count on it having any clinical effect.

Q3: "Combination therapy with both warfarin and nattokinase can provide increased prophylaxis and minimize the negative attributes of solitaire warfarin treatment".

A3: This comment by Ralph Holsworth, Jr., D.O. lacks backing by scientific clinical data - no clinical study has been done to support this statement - and is, in my opinion, inappropriate and unresponsible.

Nattokinase is a soybean food content. It is a 275 amino acid peptide. It is said to have similar clot-dissolving abilities as does plasmin, an enzyme that we all have in our blood as our natural defense mechanism to dissolve unwanted blood clots. The "clot busters" used in clinical medicine (tPA=tissue plasminogen activator, streptokinase, urokinase, etc) to dissolve blood clots that have led to heart attacks, strokes, pulmonary embolism or deep vein thrombosis, all work through enhancing plasmin's action. They have to be given intravenously, because they are not active when given orally.

There are some research data that indicate that orally taken Nattokinase increases the clot dissolving activities (= fibrinolytic activity) of blood in animals and human volunteers and that it suppresses clot formation and enhances clot resolution in animals. However, to my knowledge, only one clinical study has been performed to assess whether Nattokinase has any real benefit in the prevention of blood clots in humans. In that study Nattokinase or placebo were given to individuals prior to long distance (7-8 hours) flights. Of the 92 individuals in the placebo group 7 developed a clot, all without symptoms, discovered by ultrasound; of the 94 individuals in the Nattokinase group none developed a clot. Main flaw of the study, limiting the usefulness of its conclusions, is, that the publication does not indicate whether this was a double-blinded study, or, at least, an investigator-blinded study. A non-blinded study has the potential for bias, limiting the validity of its findings and conclusions.

I think it is fair to conclude at present that Nattokinase may have some potential to protect from blood clots. However, it has not been appropriately studied in humans. Nattokinase is not a substitute for Coumadin! If you take it - don't count on it having any clinical effect. It has also not been studied regarding its safety profile, particularly when taken together with warfarin or aspirin.

As always be sure that you check with your healthcare professional before adding to or changing your current protocol.

Take Care & Be Well,
Health Dr. 2