Welcome @harp23, I had not heard of Nattokinase but I just started on Eliquis (5mg) twice a day after a trip to the ER and an overnight in the hospital for a blood clot in my leg and then one in my lungs. I don't have AFIB but do have hypertension so also take high blood pressure meds. I have to go back in January for an ultrasound to look at the clots and determine if I need to be on Eliquis a few months longer or if it is a lifetime thing. After doing a quick search and finding the following article, I think I might discuss Nattokinase with my vascular medicine care team to see if it might be an option.

"Nattokinase dissolves blood clots by directly hydrolyzing fibrin and plasmin substrate. It converts endogenous prourokinase to urokinase (uPA). It also degrades plasminogen activator inhibitor (PAI-1) and increases the level of tissue plasminogen activator (t-PA)."
--- Nattokinase: An Oral Antithrombotic Agent for the Prevention of Cardiovascular Disease:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5372539/.
I would not take Nattokinase without discussing it with my care team especially if you take any other blood thinners or medications. Here are a few more research articles:

"Nattokinase has not been approved by the FDA, and contrary to claims on the internet, it should not take the place of an anticoagulant."
--- Can I replace prescribed anticoagulants with Nattokinase?: https://www.stoptheclot.org/faq/can-i-replace-prescribed-anticoagulants-with-nattokinase/

--- Nattokinase: A Promising Alternative in Prevention and Treatment of Cardiovascular Diseases: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6043915/.

Have you discussed it with your doctor?

Hi, @harp23. Welcome to our ongoing discussions about anticoagulants (sometimes called "blood thinners") by patients exploring whether to start using them. Your condition seems very similar to mine over the last several years -- A-fib, small stroke, anticoagulant, concern about side effects. I have a more serious issue to raise presently. First, though, my A-fib is essentially asymptomatic, normal heart rate over the last 50 years or more (except for the short time after A-fib was diagnosed and a short time later when I suffered a small stroke), relatively good health otherwise for an 80-year-old man, taking a 5mg dose of anticoagulant every day, no upgraded treatment for my A-fib since the beginning.

My "more serious issue" is something you didn't mention -- antidotes for anticoagulants. For any one of those blood-thinners, an antidote has been developed -- sometimes more than one for an anticoagulant. The problems here are numerous, not singular. Here's why I feel that way: A friend from down the street fell off a step ladder in his garage just before I drove by and saw him in pain and blood from his head. I called 911, and the ambulance was there promptly and took him to the new hospital a mile away -- minutes away. In that emergency room with him was his wife who provided immediate information on his medications, which included an anticoagulant. But within a half-hour, he was on a helicopter for a 35-mile ride to a major hospital for treatment of a bleeding head wound. By the time his wife and children could catch up with him in the other hospital, he was in critical condition and died in their arms.

What happened? The crucial factor was that the first hospital he was taken to DID NOT HAVE AN ANTIDOTE IN STOCK for the anticoagulant that he had been on for several years. So he essentially bled to death.

That tragedy overwhelms me every time I go to a clinic or urgent care program or emergency room. So my first question at the outset of every one of those places is whether they have the most recent up-to-date antidote for my "blood thinner." Twice in the half-dozen times I had to ask that question, the answer I got was, "We'll get some brought in from another hospital right away." In both cases, I quickly left the facility and had family or friend take me to a clinic I knew I could trust. I always arrange for friends or family to be with me, right behind the 911 ambulance, for this purpose.

Whatever anticoagulant you are using, check several times a year to see what the latest and most effective antidote is for THAT SPECIFIC "blood thinner" and whether the antidote is available wherever you may need it. Take care and join me in making sure nobody else is told to take aspirin as an antidote for their anticoagulants. Martin

I have infrequent episodes of paroxsymal A-Fib for 2 years. I was able to taper off of Flecainide twice a day to PIP. I also stopped Eliquis until recently when I experienced an overnight episode of asymptomatic AFib while I was asleep. My Apple Watch detected the irregular rhythm and sent out alerts. I saw them in the morning, checked my ECG, and took 75 mg of Flecainide and Eliquis. Two hours later my heart rhythm was normal

I have an appointment with my EP to discuss adding the food Natto, which is a staple in certain Asian diets, instead of the supplement Nattokinase, and a small dose of Eliquis. I feel there is less of a toxicity risk with eating Natto instead of the supplement. I don't want to take 5 mg twice a day of Eliquis for reasons others have stated.