NutriStack
Nattokinase and Prasugrel, a caution.
Nattokinase has fibrinolytic and anticoagulant effects that can stack with prasugrel's potent antiplatelet effect. A case report describes cerebellar hemorrhage after nattokinase was added to aspirin, and human studies show nattokinase can reduce fibrinogen and factors VII and VIII. Combining it with prasugrel may increase bleeding risk, especially after stent placement, stroke, surgery, or in older adults.
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
- Nattokinase and Prasugrel
- Pair type
- Caution
- Evidence (highest tier)
- Emerging
- Source citations
- 3 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 and anticoagulant effects that can stack with prasugrel's potent antiplatelet effect. A case report describes cerebellar hemorrhage after nattokinase was added to aspirin, and human studies show nattokinase can reduce fibrinogen and factors VII and VIII. Combining it with prasugrel may increase bleeding risk, especially after stent placement, stroke, surgery, or in older adults.
Mechanism. Prasugrel irreversibly inhibits platelet P2Y12 receptors, reducing ADP-mediated platelet aggregation. Nattokinase cleaves fibrin and can lower fibrinogen, factor VII, and factor VIII, creating additive impairment of clot formation and clot stability.
Recommendation. Avoid nattokinase while taking prasugrel unless your cardiologist specifically approves it. Do not use nattokinase as a substitute for prescribed antiplatelet therapy. Seek urgent care for severe headache, weakness on one side, black stools, vomiting blood, or bleeding that does not stop.
Sources (3)
- 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, Shen MC, Lin JS, Wen YK, Hwang KL, Cham TM, 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
- Kurosawa Y, Nirengi S, Homma T, Esaki K, Ohta M, Clark JF, et al. A single-dose of oral nattokinase potentiates thrombolysis and anti-coagulation profiles. Sci Rep. 2015;5:11601. PMID 26109079
Stack Score
How this pair moves the number.
Effect on the composite score
If both Nattokinase and Prasugrel 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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