NutriStack
Clopidogrel and Nattokinase, a caution.
Nattokinase is a fibrinolytic enzyme that degrades fibrin and reduces clotting factors. Combined with clopidogrel's P2Y12-mediated platelet inhibition, the additive effect substantially raises bleeding risk, especially intracranial bleeding in patients with cerebrovascular disease.
One pair, every claim cited. The two substances, the type, the mechanism, the recommendation, and the primary literature.
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What the row says.
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At a glance
- Substances
- Clopidogrel and Nattokinase
- Pair type
- Caution
- Evidence (highest tier)
- Emerging
- Source citations
- 2 sources
- Stack Score effect
- −5 to your Stack Score (per scored caution row).
- Scope
- Supplement × Prescription
- Last verified
- May 30, 2026
Caution · Emerging evidence
Caution
What is happening. Nattokinase is a fibrinolytic enzyme that degrades fibrin and reduces clotting factors. Combined with clopidogrel's P2Y12-mediated platelet inhibition, the additive effect substantially raises bleeding risk, especially intracranial bleeding in patients with cerebrovascular disease.
Mechanism. Nattokinase directly cleaves fibrin and activates plasminogen, reducing fibrinogen and factor VII/VIII. These add to clopidogrel's irreversible blockade of platelet P2Y12 receptors.
Recommendation. Do not combine nattokinase with clopidogrel. If you have been taking both, stop the nattokinase and contact your prescriber, particularly if you have any history of stroke or unusual bruising or bleeding.
Sources (2)
- Chang YY, Liu JS, Lai SL, Wu HS, Lan MY. Cerebellar hemorrhage provoked by combined use of nattokinase and aspirin in a patient with cerebral microbleeds. Intern Med. 2008;47(5):467-9. PMID 18310985
- Elahi MM, Choi CH, Konda S, Shake JG. Consequence of patient substitution of nattokinase for warfarin after aortic valve replacement with a mechanical prosthesis. Proc (Bayl Univ Med Cent). 2015;28(1):81-2. PMID 25552810
Stack Score
How this pair moves the number.
Effect on the composite score
If both Clopidogrel and Nattokinase are in the same stack, this pair applies −5 to your Stack Score (per scored caution row).
The full algorithm, the clamping rules, and four worked stacks are documented at /methodology/stack-score.
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