How long before a colonoscopy should I stop taking nattokinase?

Nattokinase Discontinuation Before Colonoscopy

You should stop taking nattokinase at least 3 days before your colonoscopy to minimize bleeding risk, similar to direct oral anticoagulants (DOACs). 1

Understanding Nattokinase and Bleeding Risk

Nattokinase is a serine protease derived from natto (a traditional Japanese fermented soybean food) with significant fibrinolytic and antithrombotic properties 2. Although not classified as a prescription anticoagulant, nattokinase has blood-thinning effects that can increase bleeding risk during invasive procedures like colonoscopy.

Pharmacokinetics of Nattokinase

• Peak serum levels occur approximately 13.3 ± 2.5 hours after ingestion 2
• Detectable in blood for up to 24 hours after a single dose 2

Recommended Management

Based on the British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guidelines for anticoagulants with similar properties:

For Colonoscopy Without Polypectomy (Low-Risk Procedure)

• Stop nattokinase the morning of the procedure 1

For Colonoscopy With Possible Polypectomy (High-Risk Procedure)

• Stop nattokinase 3 days before the procedure 1
• This timing aligns with recommendations for DOACs, which have similar anticoagulant effects

Resuming Nattokinase After Colonoscopy

• Resume nattokinase 2-3 days after the procedure, particularly if polypectomy was performed 1
• This allows adequate time for healing at any biopsy or polypectomy sites

Important Considerations

Risk of Post-Polypectomy Bleeding

• Colonoscopy with polypectomy is classified as a high-risk procedure for bleeding 1
• Most post-colonoscopy bleeding complications occur within 14 days, with 96% occurring within the first two weeks 3

Communicating with Your Healthcare Provider

• Inform your gastroenterologist about your nattokinase use before the procedure
• Follow the bowel preparation instructions carefully, as this is separate from anticoagulation management 1

Special Circumstances

If you're taking nattokinase for a specific medical condition, consult with the prescribing healthcare provider about:

• The safety of temporarily discontinuing nattokinase
• Whether any alternative measures should be taken during the discontinuation period

This approach balances the need to minimize bleeding risk during colonoscopy while ensuring your safety throughout the perioperative period.