Mountain and stream

Naturopathic Anticoagulation and Thrombosis Prevention

Stephen W. Parcell, N.D.
NatureMed Integrative Medicine
Boulder, CO

  1. Lumbrokinase: Acute conditions 2 capsules three times day 30 minutes before meals for 3-4 weeks. For maintenance and prevention: 1 capsule 1-3 times per day 30 minutes before meals. Lumbrokinase is a fibrinolytic enzyme purified from the earthworm Lumbricus rubellus. The effect of lumbrokinase is related to the inhibition of the intrinsic coagulation pathway and the activation of fibrinolysis via an increase of t-PA activity[1]. Lumbrokinase also referred to as: earthworm powder, fibrinolytic enzymes, earthworm powder enzymes (EPE), e-PPA, and Boluoke. The earthworm’s ability to break down fibrin was reported by Fredericq and Krukenberg in the 1920’s. Since then, some Japanese scholars like Mihara Hisashi succeeded in extracting fibrin dissolving enzyme from Lumbricus rubellus, and found that this enzyme consists of six proteolytic enzymes, which are collectively named Lumbrokinase. Boluoke is easily taken, has few side effects and no hemorrhage risk, it can be used as long-term anticoagulant agent in accessory treatment of coagulation disorders. Since Boluoke has no gastrointestinal reaction, it can be used as a substitute for patients who are unable to tolerate aspirin.
  2. Nattokinase 4000 activity units day: Recently a new enzyme with potent fibrinolytic activity that rivals pharmaceutical agents has been discovered and shows great potential in providing support for hypercoagulative states. Nattokinase is extracted and highly purified from a traditional Japanese food called Natto. Natto is a fermented cheese-like food that has been used in Japan for over 1000 years for its popular taste and as a folk remedy for heart and vascular diseases. A fermentation process produces Natto by adding Bacillus natto, a benefical bacteria, to boiled soybeans. Natto is a potent fibrinolytic enzyme having four times greater fibrinolytic activity than plasmin. Nattokinase inactivates plasminogen activator inhibitor (PAI-1) by limited proteolysis of its reactive site. This mechanism seems to allow this profibrinolytic enzyme to initiate effective lysis of PAI-1-enriched fibrin clots [2]. The human body produces several types of enzymes for making thrombus, but only one main enzyme for breaking it down and dissolving it – plasmin. The properties of nattokinase closely resemble plasmin. According to Dr. Martin Milner, from the Center for Natural Medicine in Portland, Oregon, what makes nattokinase a particularly potent treatment, is that it enhances the body’s natural ability to fight blood clots in several different ways; Because it so closely resembles plasmin, it dissolves fibrin directly. In addition, it also enhances the body’s production of both plasmin and other clot-dissolving agents, including urokinase
  3. Serrapeptase 10, 20, 30 mg on empty stomach: Serrapeptase, also known as Serratia peptidase, is a proteolytic enzyme isolated from the non-pathogenic enterobacteria Serratia E15. When consumed in unprotected tablets or capsules, the enzyme is destroyed by acid in the stomach. However, enterically-coated tablets enable the enzyme to pass through the stomach unchanged, and be absorbed in the intestine. Clinical studies show that serrapeptase induces fibrinolytic, anti-inflammatory and anti-edemic (prevents swelling and fluid retention) activity in a number of tissues, and that its anti-inflammatory effects are superior to other proteolytic enzymes. Besides reducing inflammation, one of serrapeptase’s most profound benefits is reduction of pain, due to its ability to block the release of pain-inducing amines from inflamed tissues. Physicians throughout Europe and Asia have recognized the anti-inflammatory and pain-blocking benefits of this naturally occurring substance and are using it in treatment as an alternative to salicylates, ibuprofen and other NSAIDs [3].
  4. Vitamin C 3000-5000 mg/day.
  5. Vitamin E 800 IU. Decreases platelet aggregation, antioxidant.
  6. Asprin 81 mg with a meal.
  7. Bromelain and other proteolytic enzymes (Wobezyme, Proteozyme) 1000-2000 mg on empty stomach. Reduces fibrin formation.
  8. Omega 3 fatty acids 4000 mg of EPA/DHA. Reduces aggregation of red blood cells.
  9. Garlic extracts 2 capsules/day. Inhibits platelet aggregation and adhesion.
  10. Ginkgo extract. Inhibits thromboxane A2.
  11. Green tea 1-10 cups or 300-600 of the extract.
  12. Flavanoids (bilberry pycnogenol). Maintains capillary integrity, reduces oxidative damage and protects against abnormal platelet activity.
  13. Lifestyle
    • Avoid inactivity, junk food, coffee, smoking, tans fats and high stress
    • Drink 8-10 glasses of water daily
    • Eat plenty of fruits and vegetables
  14. Tests
    • PPT/ PT/ INR
    • Fibrinogen
    • D-dimer of fibrin
    • PAI-1
    • Von willibrand factor
    • Factor VI Leiden
    • There are many more tests that I use. This is just a guideline.
  15. ANTICOAGULANT THERAPY – drug – herb interactions: Warfarin, a vitamin K antagonist originally derived from the sweet clover plant, has a narrow therapeutic window which needs to be monitored using prothrombin international normalized ratios (PT-INR). There are many herbs which can increase the risk for bleeding when combined with warfarin, either by enhancing the anticoagulant effects of the drug, thereby increasing the PT-INR levels, or through intrinsic anti-platelet properties, without altering the PT-INR levels. It is sometimes difficult to predict the increased risk for bleeding among these individuals, especially when formulas contain many herbs. Some case reports of coagulation complications have been reported due to the following herbs: garlic, Ginkgo biloba, quilinggao, herbal tea, ginseng, danshen and devil’s claw. Herbs that may potentiate the anticoagulant effects of warfarin are agrimony, angelica, anise, arnica, asasoetida, bogbean, borage seed, celery, chamomile, clove, Cordyalis yanhuso, danshen, devil’s claw, fenugreek, feverfew, garlic, Geum japonicum, ginger, Ginkgo biloba, ginseng, green tea, horse chestnut, licorice, lovage root, magnolia bark, meadowsweet, onion, papain, parsley, passionflower, pau d’arco, pineapple, poplar, prickly ash, red clover, red pepper, reishi, rue, skullcap, sweet clover, turmeric, uassia, willow bark and wintergreen leaf. “Herbal Remedies and Anticoagulant Therapy,” Samuels N, Thromb Haemost, 2005;93:3-7. (Address: Dr. Noah Samuels, (FAX) 972-2-5849825, E-mail: 43489


[1] Changes in coagulation and tissue plasminogen activator after the treatment of cerebral infarction with lumbrokinase. Clin Hemorheol Microcirc. 2000;23(2-4):213-8.

[2] The profibrinolytic enzyme subtilisin NAT purified from Bacillus subtilis Cleaves and inactivates plasminogen activator inhibitor type 1. J Biol Chem. 2001 Jul 6;276(27):24690-6. Epub 2001 Apr 26.

[3] Evaluation of Serratia peptidase in acute or chronic inflammation of otorhinolaryngology pathology: a multicentre, double-blind, randomized trial versus placebo. J Int Med Res. 1990 Sep-Oct;18(5):379-88.