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Nattokinase and Ticagrelor, a caution.
Nattokinase can add fibrinolytic and anticoagulant effects to ticagrelor's potent antiplatelet action. Human studies show nattokinase lowers clotting-related proteins, and a published case report describes cerebellar hemorrhage after nattokinase was combined with aspirin. The combination is especially concerning in anyone with prior stroke, recent PCI, dual antiplatelet therapy, kidney disease, or upcoming procedures.
One pair, every claim cited. The two substances, the type, the mechanism, the recommendation, and the primary literature.
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At a glance
- Substances
- Nattokinase and Ticagrelor
- 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 can add fibrinolytic and anticoagulant effects to ticagrelor's potent antiplatelet action. Human studies show nattokinase lowers clotting-related proteins, and a published case report describes cerebellar hemorrhage after nattokinase was combined with aspirin. The combination is especially concerning in anyone with prior stroke, recent PCI, dual antiplatelet therapy, kidney disease, or upcoming procedures.
Mechanism. Ticagrelor reversibly inhibits platelet P2Y12 receptors and reduces ADP-driven platelet activation. Nattokinase promotes fibrinolysis and can lower fibrinogen, factor VII, and factor VIII, so the combination can impair both platelet plug formation and fibrin clot stability.
Recommendation. Avoid nattokinase while taking ticagrelor unless your cardiologist has explicitly approved it. Do not manage this by separating doses because both effects persist beyond the dosing window. Get urgent help for severe headache, one-sided weakness, black stools, vomiting blood, or uncontrolled bleeding.
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 Ticagrelor 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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