NutriStack
Enoxaparin and Nattokinase, a caution.
Nattokinase has fibrinolytic activity and can reduce clotting factor levels. Enoxaparin potentiates antithrombin activity against factor Xa, so the combination may substantially weaken clotting through separate mechanisms. The risk is highest after surgery, with kidney impairment, or when other antiplatelet or anticoagulant drugs are present.
One pair, every claim cited. The two substances, the type, the mechanism, the recommendation, and the primary literature.
Same shape as the other 1,729 pairs in the public database.
From the interaction database
What the row says.
Every entry follows the same shape: what is happening, the mechanism, the recommendation, and the primary literature.
At a glance
- Substances
- Enoxaparin 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 has fibrinolytic activity and can reduce clotting factor levels. Enoxaparin potentiates antithrombin activity against factor Xa, so the combination may substantially weaken clotting through separate mechanisms. The risk is highest after surgery, with kidney impairment, or when other antiplatelet or anticoagulant drugs are present.
Mechanism. Nattokinase directly degrades fibrin and lowers fibrinogen, factor VII, and factor VIII. Enoxaparin enhances antithrombin-mediated factor Xa inhibition, so combined use affects both fibrin formation and fibrin breakdown.
Recommendation. Avoid nattokinase while using enoxaparin. If the combination has already been used, stop nattokinase and watch for bruising, nosebleeds, black stools, blood in urine, severe headache, or sudden weakness.
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):467-469. PMID 18310985
- Hsia CH, et al. Nattokinase decreases plasma levels of fibrinogen, factor VII, and factor VIII in human subjects. Nutr Res. 2009;29(3):190-196. PMID 19358933
Stack Score
How this pair moves the number.
Effect on the composite score
If both Enoxaparin 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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