Combining the natural enzyme supplement nattokinase with the potent prescription anticoagulant Eliquis (apixaban) is highly discouraged by medical experts and can result in severe and potentially life-threatening bleeding episodes. Both substances work to prevent blood clotting, and when taken together, their effects are compounded, leading to excessive and uncontrolled anticoagulation. Before considering any changes to your medication regimen, or adding any new supplements, it is critical to consult with your healthcare provider to understand the serious risks involved.
How Eliquis and Nattokinase Affect Blood Clotting
To understand the danger of combining these two agents, it is important to first grasp how each one works individually.
Eliquis: A Selective Anticoagulant
Eliquis, the brand name for apixaban, is a direct-acting oral anticoagulant (DOAC) prescribed to prevent or treat dangerous blood clots. It works by targeting and inhibiting a specific enzyme in the blood clotting process called Factor Xa (FXa). By blocking FXa, Eliquis effectively slows down the entire coagulation cascade, reducing the blood's ability to form clots. This selective mechanism makes it a highly effective and reliable medication, but also means its effects must be carefully managed to prevent excessive thinning of the blood.
Nattokinase: A Natural Blood Thinner
Nattokinase is a natural enzyme extracted from natto, a traditional Japanese food made from fermented soybeans. It is often marketed as a dietary supplement for its purported cardiovascular benefits, including its ability to thin the blood and improve circulation. The primary mechanism of action for nattokinase is its direct ability to break down fibrin, a protein that forms the mesh-like structure of a blood clot. It also increases the body's natural fibrinolytic activity by cleaving and inactivating the plasminogen activator inhibitor-1 (PAI-1).
The Dangerous Combination: Eliquis and Nattokinase
When Eliquis and nattokinase are taken concurrently, they do not simply add to each other's effects; they create a compounded and unpredictable risk of bleeding. Eliquis suppresses the formation of new clots by inhibiting Factor Xa, while nattokinase actively works to dissolve existing fibrin and increase fibrinolytic activity. This dual-action attack on the body's clotting ability can lead to a dangerous state of anticoagulation, where the blood's ability to clot is severely compromised. This can result in spontaneous and uncontrollable bleeding.
Documented Dangers and Adverse Events
Medical literature and reports have documented serious adverse outcomes from combining natural blood-thinning supplements with prescription anticoagulants or even from self-treating with supplements alone:
- Internal bleeding: Cases of severe internal bleeding, including hemoperitoneum (bleeding into the abdominal cavity), have been reported in individuals taking nattokinase, sometimes without other anticoagulants.
- Thrombotic events: In one notable case, a patient with a mechanical aortic valve suffered thrombosis (a major clot) after self-substituting warfarin with nattokinase, which resulted in a repeat valve replacement. This highlights that relying on supplements for critical anticoagulant therapy is extremely unsafe.
- Increased risk before surgery: Both nattokinase and Eliquis must be discontinued before surgical procedures, including dental surgery, to minimize bleeding risk. Combining them further complicates and intensifies this risk.
Comparison: Nattokinase vs. Eliquis
| Feature | Nattokinase | Eliquis (Apixaban) |
|---|---|---|
| Classification | Dietary Supplement | Prescription Anticoagulant (DOAC) |
| Mechanism | Directly breaks down fibrin; boosts natural fibrinolytic activity. | Selectively inhibits Factor Xa, a key clotting enzyme. |
| FDA Regulation | Regulated as a supplement; safety and efficacy not reviewed by FDA. | FDA-approved prescription medication; safety and efficacy rigorously tested. |
| Monitoring | No standardized monitoring, making its effect unpredictable. | Standard dosing, no routine blood tests needed, but clinical monitoring is essential. |
| Safety in Combination | High risk of dangerous interactions with anticoagulants. | Designed for safety and efficacy under medical guidance. |
| Substitution | NEVER substitute for prescribed anticoagulants. | Should only be prescribed and managed by a healthcare provider. |
Crucial Steps for Patients
If you are currently taking Eliquis and are considering adding nattokinase, or if you are already taking both, follow these steps:
- Do not stop Eliquis suddenly. Discontinuing a prescription anticoagulant without medical supervision can significantly increase the risk of a new blood clot.
- Contact your healthcare provider immediately. Discuss your use of nattokinase and any other supplements. Be completely transparent about what you are taking and how often.
- Heed all medical advice. Your doctor may advise you to stop the nattokinase immediately and will monitor your condition closely.
- Know the signs of bleeding complications. Promptly seek emergency medical attention if you experience severe headaches, red or brown urine, black or tarry stools, excessive bruising, or any other signs of uncontrolled bleeding.
Conclusion: The Final Verdict
Based on established pharmacological principles and documented case reports, combining nattokinase and Eliquis is a high-risk practice that can lead to severe and dangerous bleeding complications. The mechanisms of action for both substances intensify blood-thinning effects beyond a safe therapeutic range when used together. As with any combination of a potent prescription drug and an unregulated dietary supplement, this should be avoided unless explicitly directed and closely monitored by a qualified healthcare professional. For patients on Eliquis, the safest course of action is to stick to your prescribed medication and avoid adding any new supplements without a thorough discussion with your doctor.
