Alternative AntiCoagulation to Warfarin/NOAC's

I know this subject has been covered here before at length. I have read some of the old Threads, and if someone refers me to another old Post, that is fine. Bypassing the question of whether or not something like Nattokinese can replace, or is advisable in comparison with taking a real NOAC or Warfarin, I ask the following:

1) What is the best alternative option? Natto/Nattokinase has been discussed. Should other substances like Fish Oil be taken with the Natto?

2) Is there a test to determine if an alternative Blood Thinner is working? If I get a PT/INR blood test and it shows that my blood is taking long enough to Coagulate, then am I sufficiently covered?

3) Why is not PT/INR tested at baseline prior to initiating Anti-Coagulation therapy? Or does this test not analyze everything involved in accessing and preventing Clot formation?

Thankyou for any and all responses however brief or long.



Edited 1 time(s). Last edit at 05/20/2021 03:00PM by The Anti-Fib.

The Anti-Fib,
There is a study called the "Nattokinase Atherothrombotic Prevention Study (NAPS)" that is due to be released this month that should shed more light on the effectiveness of nattokinase.
Keep your eye out for it.

[clinicaltrials.gov]

Dean

Quote
The Anti-Fib
I know this subject has been covered here before at length. I have read some of the old Threads, and if someone refers me to another old Post, that is fine. Bypassing the question of whether or not something like Nattokinese can replace, or is advisable in comparison with taking a real NOAC or Warfarin, I ask the following:

1) What is the best alternative option? Natto/Nattokinase has been discussed. Should other substances like Fish Oil be taken with the Natto?

2) Is there a test to determine if an alternative Blood Thinner is working? If I get a PT/INR blood test and it shows that my blood is taking long enough to Coagulate, then am I sufficiently covered?

3) Why is not PT/INR tested at baseline prior to initiating Anti-Coagulation therapy? Or does this test not analyze everything involved in accessing and preventing Clot formation?

Thankyou for any and all responses however brief or long.

Hans Larsen published the 3rd edition of his stroke book in April 2018. It is here <[www.amazon.com] I have a copy, but its been 18 months since I read it and am traveling at the moment. I recall he was very thorough.

The PT/INR test measures only how well warfarin/Coumadin is working. Other drugs should have no effect on it.

[labtestsonline.org]

AntiFib – I’m short on time, but go into the archived posts such as the following ...... on the influence of ‘silent inflammation’ and the risk stroke and MI. There are several posts that describe the consequences of ‘thick, sticky blood’ and appropriate lab testing to evaluate one’s status for "clot risk'.

This one lists the links.
[www.afibbers.org]

If you like, send me a PM and I can elaborate, since I had the 'clot experience' and relied on natural preventives including nattokinase along with pycnogenol and several other supplements that help reduce the factors that contribute to clot risk... because I didn't tolerate coumadin.

Jackie

Antifib,

I take Natto and nattokinase, I take Natto every 2nd day and one nattokinase capsule before bed, on the other days I take two nattokinase capsules. One in the morning and one at night. Natto has many other benifets not just thinning blood, even if it doesn't reduce your afib burden. Btw I've only had 3 afib events this year.
I am over 75 and this is my choice of alternative Blood Thinner which my doctor has agreed to.

Below is a link to some information you may find helpful with regard to natural blood thinning and testing.


[ndnr.com]

Colin

Thankyou everyone for the great and informative responses/resources. Each response is useful. I was aware of the pending Natto Study, and the results will hopefully clarify things concerning Natto Anti-Coagulation issue.

I am thinking that an area that is not factored into Stroke risk would be a persons chronic or usual Hydration status. Some people consume more fluids than others. Being dehydrated would cause thicker Blood, and conversely, over-hydrating would yield thinner blood. I have seen where dehydration is linked with increased Stroke risk, but has anyone seen or heard of keeping a person mildly over-hydrated would decrease Stroke risk? Maybe a Blood viscosity test would help define this?



Edited 1 time(s). Last edit at 09/30/2019 08:02AM by The Anti-Fib.

Quote
The Anti-Fib
Maybe a Blood viscosity test would help define this?

I think a blood sugar test would give you an idea of the condition of your blood, not only could you check your blood sugar levels but you could also see how easily your blood flows out after the prick. I noticed after i started taking nattokinase and natto i got more blood sample than before.

Before having a stroke I would think your blood would be in bad shape and your artries would be clogged up with calcium and fat etc.
Natto dissolve calcium and softens up your artries making for your blood to flow easier, helping to reduce blood pressure. It also contains up to one billion probiotics per gram. Dr Axe has a great description of the benifets of Natto. [draxe.com]



Edited 1 time(s). Last edit at 09/30/2019 12:15PM by colindo.

Quote
colindo
Before having a stroke I would think your blood would be in bad shape and your artries would be clogged up with calcium and fat etc.

Not necessarily. Perfectly healthy young people with pristine arteries can and do suffer strokes. Even children do. It depends on the cause of the stroke, many of which have nothing to do with arterial plaque, fat, calcium, hydration level, etc. Afib-related strokes are a good example.

Quote
Carey

Before having a stroke I would think your blood would be in bad shape and your arteries would be clogged up with calcium and fat etc.

Not necessarily. Perfectly healthy young people with pristine arteries can and do suffer strokes.

What then causes the stroke?
A new water pipe won't block, a rusty one will.

Quote
colindo
What then causes the stroke?
A new water pipe won't block, a rusty one will.

Well, blood stagnating in the left atrium because it's not pumping effectively is the best example for this forum. That can happen to a very healthy 30-year old just as easily as it can to a very sick 80-year old. Just because your pipes are new and free of rust doesn't mean a big old clot of crud won't block them. That's how most afib-related strokes happen. It's not because the person has vascular disease and is full of plaque and arteries full of crud. It's because blood pools in their left atrium and clots form there that eventually get pumped out and travel to the brain.

There are a bunch of other ways for clots to form that can cause strokes, even in healthy people with pristine arteries. Surgery, injuries, infections, cancer, even just taking birth control pills -- there are many ways for a clot to form that can travel to your brain and cause a stroke other than clogged arteries.

The clinical trial cited above is to measure natto effectiveness against artherosclerosis and cognitive decline. Hopefully it will succeed. However, there seems to be no evidence that natto is useful for afib related stroke. In fact, one study shows that a very large dosage of natto is required to achieve the same anticoagulative effect as a standard dosage of aspirin at least in an animal model. This suggests why natto may not be effective against afib, i.e., because it has too weak of an anticoagulant action for afib type clots.

Quote
safib
However, there seems to be no evidence that natto is useful for afib related stroke. In fact, one study shows that a very large dosage of natto is required to achieve the same anticoagulative effect as a standard dosage of aspirin at least in an animal model. This suggests why natto may not be effective against afib, i.e., because it has too weak of an anticoagulant action for afib type clots.

That was one test, I have seen a test where by Natto's effectiveness is not far behind warfarin, which I can't find at the moment.
If I recall correctly the new anticoagulant were 70% effective, warfarin 60% and Natto 55%. Something in that order.
But Natto is so much more because it also lowers fibrinogen levels, it dissolves calcium and transports it to your bones where it belongs. It dissolves clots, and its very kind to your gut.

I know of the story of a lady who took nattokinase and had a stroke and was advise by her doctor not to. But there is no guarantee she would have avoided the stroke taking warfarin or one of the other anticoagulant.

BTW for those of you who don't know, Natto and nattokinase are two different things. Nattokinase is derived from Natto, removing the soy which in the process removes some of the other good things from Natto.

Nattokinase is now offered to passengers on all long haul flights from Japan, this is to prevent deep vein thrombosis (DVT) and pulmonary embolism (PE).



Edited 1 time(s). Last edit at 10/01/2019 01:48PM by colindo.

Quote
colindo
That was one test, I have seen a test where by Natto's effectiveness is not far behind warfarin, which I can't find at the moment.
If I recall correctly the new anticoagulant were 70% effective, warfarin 60% and Natto 55%. Something in that order.

I was unaware a study existed that compared the three. I'd like to see that if you can find it.

And I'm curious. Unless somebody is unable to tolerate all the NOACs and warfarin, why would they choose the least effective option?

Quote
colindo

That was one test, I have seen a test where by Natto's effectiveness is not far behind warfarin, which I can't find at the moment.
If I recall correctly the new anticoagulant were 70% effective, warfarin 60% and Natto 55%. Something in that order.
But Natto is so much more because it also lowers fibrinogen levels, it dissolves calcium and transports it to your bones where it belongs. It dissolves clots, and its very kind to your gut.

I searched pubmed and find no such study or test as you refer to it. Perhaps this was speculation based on some actual studies.

Quote
colindo

I know of the story of a lady who took nattokinase and had a stroke and was advise by her doctor not to. But there is no guarantee she would have avoided the stroke taking warfarin or one of the other anticoagulant.

Can you clarify the significance of this remark? It seems to be trivial and doesn't add to the discussion, but maybe I am missing something

[www.afibbers.org]

Safib,

I know you and Carey are Natto knockers and what ever I have to say you are going to kick holes in it.

I am just offering an alternative viewpoint which I believe is better for our bodies than the current medical view.

BTW that study I refer to was done in Japan so you won't find it where you are looking.

Quote
colindo
I know you and Carey are Natto knockers and what ever I have to say you are going to kick holes in it.

I'm not a natto knocker. I just don't understand why people will risk such a devastating thing as stroke on an unproven supplement. Using it as an adjunct or using it when stroke protection isn't a priority might make sense, but using it as primary protection against stroke when you have afib strikes me as a dangerous and unnecessary risk. Many people have irrational fears of anticoagulants and I don't want them reading this site and coming away thinking natto is a safe alternative.

In fact, I'm actually now in that category of people it might be appropriate for. So I'm not looking to kick holes in it. I would genuinely like to see a study that actually compared it to NOACs and warfarin. As I said above, I didn't think such a study existed.

Colin - To add support to the merits of using the enzyme, nattokinase, I’ll offer this brief history on my clot experience. You probably recall my story of long ago (2004) when I reported that after my first ablation (2003) and when I went back for the requisite 3-mo. assessment which included a spiral CT scan of the heart, and I was cleared then to go off warfarin. I immediately resumed my regular dosing of nattokinase which I had used for several years prior to ablation as I could not tolerate warfarin due to low platelets.

When my AF began in 1995, warfarin was prescribed and I had a lot of problems with regulating the INR because of low platelet count. My research for alternatives eventually led me to nattokinase and Dr. Ralph Holsworth. He shared with me data on how NK works as a fibrinolytic enzyme and helps prevent red-blood cell aggregation and told me about his research with Japanese researcher Dr. Hiroyuki Sumi at Chicago University; and, that Dr. Holsworth introduced NK here to the US. I began using his nattokinase. Although my afib was very sporadic and limited in the initial onset years, it eventually became more frequent and with many prolonged events – often lasting over 24 hours and involved numerous cardioversions. I was assigned a date for ablation in 6 months. During that time, I continued with the NK.

In my AF historical account archived here in posts long ago, there is a one that reports I had used NK for several years …up to the time in 2003 when I had my first ablation with Dr. Natale when he was in Cleveland, OH…and I did have to use warfarin for the procedure and for 3 mos. afterward, but when I was able to stop the warfarin, I went right back on the Nattokinase.

The post-ablation protocol back then was to have a spiral CT scan of the heart at three months. After having a normal post-ablation recovery period, I did have two AF events (one required cardioversion) just prior to the CT scan. The next week, I was had the 3 mo. review and was cleared to go off warfarin. What I didn’t know and learned about 6 weeks later when I requested a copy of the CT scan report for my files, was the notation indicating there was a small clot in the LAA and I posted here about ‘slipping through the cracks’ as I was unaware of that detail. The EP nurse and I “joked” about that being a good testament for the efficacy of nattokinase.

That was 2004 and I continued to use nattokinase and be evaluated for the other markers of hyperviscosity to help ensure that my senior years were safe from clot risk and have offered three reports here on that topic. Eleven years after my first Natale ablation, arrhythmia once again disrupted my life and I had to stop the NK and begin Eliquis which (for me) has many unwelcome side effects.

Background nattokinase publications:
[www.researchgate.net]

[holisticprimarycare.net]

These quotes from a Holsworth presentation help to clarify the function of NK for those who are interested in the reasons why NK is useful.

Holsworth: Tonight’s discussion I’d like to present is nattokinase, which is a pro-fibrinolytic enzyme. I’ll go into the history of that. Then I’ll relate that with the chronic inflammatory stages, and how that increases hypercoagulability states increased, or hyperviscous syndrome, where you have increased blood thickness, as well how crosslinked fibrin is involved in this process, as well as any chronic inflammatory process as well

(08-2005) Ralph Holsworth: Nattokinase Enzyme Treatment Page 6 of 39 viscosity. In other words, the blood is much thicker than what the arterial vasculature was designed to carry. So the clot plot thickens, as we’re young, and then it thickens as we become older. Again, this is crosslinked fibrin red blood cells. This is a crenulated RBC on its way out.

It’s probably 119 days old. I’ll go into that. But these become abrasive, these become sandpaper. Think of it as sand blasting. I’ll go into the theory there, the protective adaptation theory. Because blood is a non-Newtonian fluid. When the heart applies pressure or energy into it from systole diastole, it’s changing five-fold. Your blood changes its blood viscosity, the thickness, five-fold every beat of your heart and then thickens.

On the bottom x-axis we have shear. Shear is basically just energy. Once you impart energy, it describes how well things flow. During a high shear flow, we have things passing by each other very quickly. Very similar to the blood that’s getting injected into your aorta during your contraction of your left ventricle. During low shear, this would be during diastole, this is when your heart is actually feeding itself. The coronary arteries are actually feeding the myocardium. I’d like to point out, that’s actually when the blood is its thickest. If you think about it, the myocardium is getting fed at probably one of the worst points, as far as the blood flow or viscosity issues are in the blood. That’s when it’s the thickest. Here’s a number of different things, as far as sticky platelet, the rouleaux formation, C-reactive protein, triglycerides, cholesterol.

What you can see is that it affects the blood and very specific shear zones. This is why, I think, there’s just as many people with a cholesterol below 150 who have heart attacks as there are with it greater than 150 that have heart attacks. Obviously, cholesterol in and of itself is not a determining factor as who’s going to have a blood clot or not. (end of clip)


Also the research findings of Dr. Kenneth Kensey on hemorheology and rouleaux formation is worth learning about.

As you mentioned in the other thread on the reliable form of nattokinase … It’s very important to be sure it’s labeled as NSK-SD which means Natural Super Kinase–Sprayed Dried.

I have always been grateful to know about nattokinase. Even on half-dose of Eliquis, I’m bothered by side effects.

Glad you are doing so well, Colin. Thanks for posting.
Jackie


Reference: Your past post links:
[www.afibbers.org]
[smart-publications.com]

what brand NK and what dosage do you all take?

So I switch to Natto/Nattokinase along with maybe Fish Oil to achieve some level of Anti-Coagulation.
Now I am headed to my Doctors. What tests do I need to ask for to check the status of my Blood?

Blood Fibrinogen test?
PT/INR?

I know Meridian Labs has been mentioned here in the past, but there machine is down and not working, and I don't want to pay the $200 cash-pay each time I want a test. [www.meridianvalleylab.com]

I Also found this old post (2012) from Jackie [www.afibbers.org]
that lists 8 these things to test for. Some of these tests are on routine blood lab tests that I have gotten in the past.

Homocysteine
Fibrinogen
Ferritin
High Sensitivity or Cardiac C-reactive protein
Hemoglobin 1AC
Lipoprotein-a
Interleukin - 6
Oxidized LDL



Edited 2 time(s). Last edit at 10/02/2019 05:40PM by The Anti-Fib.

Jackie, another informative post. By the way I have still been eating natto food for 14yrs since you first posted about nattokinase early 2005. In that time I have eaten my way through 2,548 packets of natto food or 127 kilos!! My reward is no afib in that time.

I do agree with Carey that more large studies need to be done on nattokinase to find out what we are actually dealing with here. Until then I think caution is a good thing if you have a CHAD's score more than 1 and a high afib burden.

Also, does natto food / nattokinase interfere with the current NOAC'S? We know it affects Warfarin.

Very interesting about blood viscosity from Dr. Holsworth, especially this bit:

“He believes nattokinase can do what current drug therapies cannot: modulate blood viscosity. "Pharmaceuticals affect lipid metabolism or they biochemically modulate the clotting process. But they do not alter blood viscosity," he said. "Even aspirin, which is promoted as a "blood thinner," does not actually change viscosity; it only inhibits clotting.”

Any comments about this? How accurate is it?

Also what role does blood viscosity play in the genesis of afib? Is “sticky blood” the answer to our afib problem?

Yes, lot's of questions and very little answers as usual.

Dean

This is one of the latest PubMed research papers published in 2018 on Nattokinase and is very thorough and detailed. The research into Nattokinase is now looking very promising.

Nattokinase: A Promising Alternative in Prevention and Treatment of Cardiovascular Diseases

“Cardiovascular disease (CVD) is the leading cause of death in the world and our approach to the control and management of CVD mortality is limited. Nattokinase (NK), the most active ingredient of natto, possesses a variety of favourable cardiovascular effects and the consumption of Natto has been linked to a reduction in CVD mortality.

Recent research has demonstrated that NK has potent fibrinolytic activity, antihypertensive, anti-atherosclerotic, and lipid-lowering, antiplatelet, and neuroprotective effects. This review covers the major pharmacologic effects of NK with a focus on its clinical relevance to CVD. It outlines the advantages of NK and the outstanding issues pertaining to NK pharmacokinetics.

Available evidence suggests that NK is a unique natural compound that possesses several key cardiovascular beneficial effects for patients with CVD and is therefore an ideal drug candidate for the prevention and treatment of CVD. Nattokinase is a promising alternative in the management of CVD.”

[www.ncbi.nlm.nih.gov]

Dean

A cautionary note:

Quote
Shannon
I was on Cardiokinase at 100mg 3x/day, which is the most potent form of Nattokinase, when I had my small stroke. While concerning, its quite possible that if my stroke was due to necrotic debris from my previously closed LAA for some months, during which obvious necrosis would have taken place, and then upon the leak opening up and re-establishing blood flow between the LAA and Left atrium some of this necrotic debris could well have washed out of the remnant LAA pouch and gone right to the brain.

<[www.afibbers.org]

Shannon had a TIA after his LARIAT procedure while on Nattokinase. No prevention strategy, whether meds or supplements is 100%. As mentioned above, if I had a CHA2DS2-VASc >1, and a high AF burden, I'd personally take prescription anticoagulation meds. They aren't perfect either, but have more data behind them.

Just curious George, what will you take when you reach 75 years old, have a CHAD score of 2 and low afib burden?

We don't know if Shannon would have been taking a blood thinner if that would have prevented his TIA, his case of a hole being opened letting debris into his blood is something that the average person is not being subjected to:


* I was on Cardiokinase at 100mg 3x/day, which is the most potent form of Nattokinase, when I had my small stroke. While concerning, its quite possible that if my stroke was due to necrotic debris from my previously closed LAA for some months, during which obvious necrosis would have taken place, and then upon the leak opening up and re-establishing blood flow between the LAA and Left atrium some of this necrotic debris could well have washed out of the remnant LAA pouch and gone right to the brain.

If so, there is no surety that any blood thinner, including warfarin or the NOACS, would have been as effective in preventing such a necrotic debris based CVA as they generally might be with a more typical thrombi-embolic origin stroke. It is also true that my stroke could have been due to thrombi-embolic debris as well, since this origin has been confirmed as a risk from late leaks in previously surgically ligated LAAs.

L

Quote
colindo
Just curious George, what will you take when you reach 75 years old, have a CHAD score of 2 and low afib burden?

Assuming it is only age in my CHADs score and my afib burden is unchanged, probably only the fish oil I consume today.

Anti-Fib - Those tests you listed from the Clot Risk report are used to determine "influences" on factors that can lead to blood hyperviscosity.... especially important is the C-reactive protein which is the inflammatory factor marker. I have them done every 6 mos just to be sure I'm in healthy range... even thought I continue to take the half-dose of Eliquis ... because those markers are important for overall health as well.

Dean - here's a collection of some of the NK studies... some more recent ...showing benefits for a variety of uses... so your practice is bound to keep you healthy on a number of levels. Good for you!

Jackie



Efficacy of Nattokinase – collection of study findings*

Nattokinase is a proteolytic enzyme whose principle effect is fibrinolysis or degradation of fibrin, a fibrillar protein that when linked together forms the mesh essential for blood clot formation. Nattokinase also upregulates the body’s natural mechanism that guards against excess fibrin formation. Nattokinase may support healthy blood clotting, circulation, and platelet function by helping to maintain optimum function of the body’s normal fibrinolytic processes

A combination of pine bark extract and nattokinase prevents venous thrombosis in long-haul flights. Angiology. 2003 Sep-Oct;54(5):531-9. [www.ncbi.nlm.nih.gov]

These results support the safety of nattokinase as an agent for cardiovascular diseases prevention.
Acute toxicity and genotoxicity evaluations of Nattokinase, a promising agent for cardiovascular diseases prevention.
Regul Toxicol Pharmacol. 2019 Apr ;103:205-209. Epub 2019 Feb 8. PMID: 30742876
[www.ncbi.nlm.nih.gov]

This review covers the history, benefit, safety, and production of nattokinase.
Nattokinase: An Oral Antithrombotic Agent for the Prevention of Cardiovascular Disease.
Int J Mol Sci. 2017 Feb 28 ;18(3). Epub 2017 Feb 28. PMID: 28264497

Nattokinase could be a good candidate without adverse effects for the improvement of blood flow. Nov 30, 2013
Abstract Title: Nattokinase improves blood flow by inhibiting platelet aggregation and thrombus formation.
Lab Anim Res. 2013 Dec ;29(4):221-5. Epub 2013 Dec 20. PMID: 24396387
[www.ncbi.nlm.nih.gov]

Abstract Title: Mechanisms of Nattokinase in protection of cerebral ischemia.
Eur J Pharmacol. 2014 Dec 15 ;745:144-51. Epub 2014 Oct 27. PMID: 25446567
[www.ncbi.nlm.nih.gov]

Nattokinase reduces red blood cell aggregation.
Abstract Title: Effects of nattokinase, a pro-fibrinolytic enzyme, on red blood cell aggregation and whole blood viscosity.
Clin Hemorheol Microcirc. 2006;35(1-2):139-42. PMID: 16899918


Consumption of nattokinase was associated with a reduction in both systolic and diastolic blood pressure.
Integr Blood Press Control. 2016 ;9:95-104. Epub 2016 Oct 13. PMID: 27785095
[www.ncbi.nlm.nih.gov]

Nattokinase supplementation is an effective way to manage the progression of atherosclerosis and potentially may be a better alternative to statins. Jul 10, 2017
Abstract Title: A clinical study on the effect of nattokinase on carotid artery atherosclerosis and hyperlipidaemia.
Zhonghua Yi Xue Za Zhi. 2017 Jul 11 ;97(26):2038-2042. PMID: 28763875

Nattokinase combined with red yeast rice, but not nattokinase alone, has potent effects on blood lipids in human subjects with hyperlipidemia.Jan 01, 2009
Asia Pac J Clin Nutr. 2009;18(3):310-7. PMID: 19786378
[www.ncbi.nlm.nih.gov]


Nattokinase decreases plasma levels of fibrinogen, factor VII and factor VIII in human subjects. Mar 01, 2009
Nutr Res. 2009 Mar;29(3):190-6. PMID: 19358933
[www.ncbi.nlm.nih.gov]

Effects of nattokinase on blood pressure: a randomized, controlled trial.
J Cell Physiol. 2010 Jun;223(3):771-8. PMID: 18971533

Dietary supplementation of fermented soybean, natto, suppresses intimal thickening after endothelial injury in rat femoral artery Jul 25, 2003
Life Sci. 2003 Jul 25;73(10):1289-98. PMID: 12850244 [www.ncbi.nlm.nih.gov]

Abstract Title:
Dietary supplementation with fermented soybeans suppresses intimal thickening.
Nutrition. 2003 Mar;19(3):261-4. PMID: 12620531 [www.ncbi.nlm.nih.gov]


*Source: GMI Research on the topic of NK.

Anti-Afib i've been wondering as well - why don't they test the clotting factors/viscosity etc of one's blood prior to prescribing anti-coagulants.
I know they go by calculating the score but we all differ as well as having different dietary and exercise habits.

My answer is that it is simpler to do herd treatments and it covers the practitioner.

As the saying goes: One can not supplement and expect to compensate for a bad (individual's) diet and life style'. Drugs obviously help to deal with symptoms (and in many cases cause other problems) and not with causes.

The vegans like Dr Joel Kahn et.al. would argue that their way would largely obviate anti-coagulants except for people being in AF and perhaps a few other exceptions???

When i was 40 i prepared for a jaw operation by changing to manly vegetarian. When the surgeon did a clotting test pre-operation he asked me if i was a hemophiliac because it took 9 minutes to clot. Yes, i know there is more to getting a thrombus than checking clotting time. It's just that i suspect is was due to the changes i made - will never know for certain.

Quote
Joe
Anti-Afib i've been wondering as well - why don't they test the clotting factors/viscosity etc of one's blood prior to prescribing anti-coagulants.

Because there are few, if any, studies showing how clotting factors, viscosity, etc. predict strokes, or even if they do at all, so they have no science to guide them and no guidelines to follow. The doctor who decides not to put his CHADS 5 afib patient on an anticoagulant because of a bunch of blood work he thought up himself would probably have a very short half-life on his malpractice insurance and possibly even his license. Even if he's such a dedicated doctor that he's willing to take those risks, how does he do so ethically? Which patient does he test it on first? And if he's wrong?

Clotting seems simple but it's actually an insanely complex process. It's tempting to think you can measure a few simple things and know if someone's going to form clots, but you can't. Here's a look at how the clotting cascade works to give you an idea how complex this is:



So your job is to find a step in that cascade of events that you can interrupt to prevent clots from forming, but you can't interrupt it completely or your patient will bleed to death. I think that sounds like the work of an entire research career.

Thank you Carey, that explains it well why they stick with NOAC or warfarin!

Quote
Carey

So your job is to find a step in that cascade of events that you can interrupt to prevent clots from forming, but you can't interrupt it completely or your patient will bleed to death. I think that sounds like the work of an entire research career.

This will help.

Nattokinase is a fibrinolytic enzyme, which means that it has the ability to break down or "degrade" excessive fibrin that our bodies produce when recovering from injuries or other health issues.

Fibrin is a strong, insoluble protein that plays an essential part in blood clotting and the formation of scar tissue around the area of concern. These long fibrous tissues are key for maintaining our general health and well-being. However, slow fibrin degradation, which worsens as we age, can lead to an overproduction of fibrin in the body, becoming a catalyst for many circulatory health problems.

Studies have demonstrated that the Nattokinase enzyme acts as a booster for your body to be able to naturally make more plasmin, the body's own fibrinolytic enzyme. The increased plasmin production, as well as Nattokinase's own fibrinolytic properties, give your body the 1-2 punch that it needs in order to maintain a good, healthy balance of fibrin when overproduction or slow degradation occurs. Keeping this balance will allow your blood to flow the way that it's supposed to, with minimal obstruction.

Okay, but how does knowing its mechanism of action help?

Nattokinase is a fibrinolytic enzyme, which means that it has the ability to break down or "degrade" excessive fibrin that our bodies produce when recovering from injuries or other health issues.

It is pure speculation to suggest that some enzymatic action is related to an effective therapy for AF stroke risk. Some generic mechanistic action does not establish anything. The argument is not bolstered by listing preliminary or irrelevant studies just because they involve the same compound. Many people here are big on supplements, that's fine and most would agree it is harmless. Fibrinolytic enzymes are another thing altogether. There are so many potential issues with dosing and interactions. I don't know why this isn't held to the same standards as evaluating surgical interventions like cardiac ablation. Substituting Nattokinase fully or in part for NOACs to deal with AF stroke risk is not supported by any evidence that it works. I suspect that MDs who are confronted by patients making such requests sometimes acquiesce for the same kinds of reasons that they accede to requests for other medications, which of course is not good practice.You might as well bypass the MDs if you want to go this route: they probably know less than you do about Natto and would appreciate not having to take risks.

Quote
colindo
Nattokinase is a fibrinolytic enzyme, which means that it has the ability to break down or "degrade" excessive fibrin that our bodies produce when recovering from injuries or other health issues.

I get that and I don't dispute it, but I'm unaware of any research showing that it's effective at preventing strokes in afib and I'm unaware of any research showing that it's safe to combine with anticoagulants. So how would a doctor ever justify substituting it or adding it as an adjunct? That's what I meant by asking how knowing its mechanism would help.