What is similar to nattokinase?

Cardiovascular disease is the world's leading cause of death, and the search for a gentler way to support healthy blood flow has made nattokinase one of the most talked-about enzymes on the supplement shelf.

If you have landed here, you already know nattokinase breaks down fibrin — the protein that holds blood clots together — and you want to know what else does a similar job. Several enzymes and everyday supplements are marketed as comparable, but the evidence behind them varies enormously: nattokinase itself has been examined in at least 6 randomized controlled trials, while some of its closest rivals have almost none. This guide compares the five most common alternatives and shows where each one actually stands.

Table of Contents

• 1. What "similar to nattokinase" really means
• 2. Serrapeptase: the most-compared enzyme
• 3. Lumbrokinase: the fibrin-specific option
• 4. Bromelain: the pineapple enzyme
• 5. Aspirin and omega-3: same goal, different mechanism
• 6. How to choose — and where nattokinase fits
• Frequently Asked Questions
• Research References

1. What "similar to nattokinase" really means

Before comparing alternatives, it helps to be specific about what nattokinase does. It is a fibrinolytic enzyme — a protein that breaks down fibrin — first isolated from natto, a fermented soybean food, in 1987. A 2018 review in Biomarker Insights describes it as having fibrinolytic, blood-pressure-lowering, anti-atherosclerotic and anti-platelet actions, and calls it "a promising alternative" for cardiovascular support.

So a supplement is "similar to nattokinase" if it does one of two things: works through the same mechanism (dissolving or preventing fibrin clots), or targets the same goal (healthier circulation and lower clot risk) by a different route. That distinction matters, because a 2021 review of microbial fibrinolytic enzymes notes that prescription clot-busters such as tPA, streptokinase and urokinase carry meaningful risks of gastrointestinal bleeding and hemorrhage, which is precisely why gentler enzyme options have drawn so much interest.

The four supplements people most often ask about fall into 2 buckets. Serrapeptase, lumbrokinase and bromelain are enzymes that work more or less like nattokinase; low-dose aspirin and omega-3 fatty acids are non-enzyme options aimed at the same cardiovascular outcome. Only 1 of these five — nattokinase — has reached the level of multiple randomized human trials, which is worth keeping in mind as we go. It also helps that nattokinase activity is measured in standardized fibrinolytic units (FU), so a labeled 2000 FU dose means roughly the same thing across reputable brands — something that is not true of every enzyme on this list.

2. Serrapeptase: the most-compared enzyme

Serrapeptase (also called serratiopeptidase) is the alternative nattokinase gets measured against most often. It is a proteolytic enzyme originally derived from bacteria in the silkworm, and it has been used for decades in Japan and Europe for inflammation, swelling and pain, with fibrinolytic activity as a secondary property.

The catch is the evidence. A systematic review in the International Journal of Surgery found that of 74 PubMed results, only about 9 were randomized controlled trials on serrapeptase's efficacy — and it judged most of them to be of poor methodology, with little safety and tolerability data. That is a markedly thinner base than nattokinase's 6 dedicated cardiovascular trials.

There is genuine laboratory promise: one in-vitro study reported that serrapeptase showed good fibrinolytic activity along with anticoagulant and thrombolytic effects in the test tube. But test-tube activity does not equal proven results in people, and the same researchers acknowledged its fibrinolytic use has not been established clinically. If your main interest is circulatory support rather than post-surgical swelling, serrapeptase is the option with the widest gap between its reputation and its human data.

3. Lumbrokinase: the fibrin-specific option

Lumbrokinase is a group of fibrinolytic enzymes extracted from the earthworm Lumbricus rubellus, and it has been used in traditional East Asian medicine for clot-related conditions. Structurally it is a small serine protease, and its defining feature is that it is fibrin-specific — it acts on fibrin without broadly disturbing other clotting factors.

Its clinical evidence sits in a different place from nattokinase's. A 2025 meta-analysis of randomized trials found that, added to standard supportive care, lumbrokinase improved neurological function and reduced markers of thrombosis in people with acute ischemic stroke. In other words, most of its human research is in a serious medical setting as an adjunct therapy, not in everyday preventive supplementation.

That fibrin-specific profile is often described as carrying a lower bleeding risk than less selective agents, which is one reason it appeals to people who react poorly to other blood thinners. Still, lumbrokinase is measured in its own units (LKUs) that vary between manufacturers, so 2 products labeled "lumbrokinase" are not necessarily equivalent — an added layer of uncertainty compared with nattokinase's standardized fibrinolytic units.

4. Bromelain: the pineapple enzyme

Bromelain is a mixture of protein-digesting enzymes concentrated in the stem of the pineapple, and it is best known as an anti-inflammatory used for swelling, sinus issues and recovery. It also has hemostatic effects, which is why it appears in conversations about nattokinase-style circulatory support.

A 2026 critical review in Frontiers in Nutrition concluded that bromelain influences clotting through at least 2 pathways — enhancing fibrinolysis and inhibiting platelet aggregation — but that the overall clinical evidence remains limited. Importantly, that same review flags that bromelain may increase bleeding risk when combined with anticoagulant or antiplatelet drugs, and is generally not recommended in people with bleeding disorders or during pregnancy.

The practical takeaway is that bromelain overlaps with nattokinase on mechanism but not on focus. Almost none of its studied uses center on cardiovascular endpoints the way nattokinase's roughly half-dozen trials do; its strongest evidence is in inflammation and recovery. As a "similar" option it is real, but it is the least targeted of the enzymes here for anyone whose goal is specifically healthy blood flow.

5. Aspirin and omega-3: same goal, different mechanism

Not everything "similar to nattokinase" is an enzyme. Many people are really choosing between nattokinase and the 2 most familiar cardiovascular staples: low-dose aspirin and omega-3 fish oil. Both aim at the same destination — lower clot and cardiovascular risk — but neither works by dissolving fibrin the way nattokinase does.

Low-dose aspirin

Aspirin (typically 81 mg) reduces clotting by irreversibly blocking platelets rather than breaking down fibrin. For years it was a default, but the guidance has narrowed sharply: based on a review of 13 randomized trials, the U.S. Preventive Services Task Force in 2022 recommended against starting low-dose aspirin for primary prevention in adults 60 and older, and advised that for adults aged 40 to 59 with a 10% or greater 10-year risk, the decision should be individual. The reason is that aspirin's bleeding risk can offset its benefit in lower-risk people — a trade-off worth discussing with a clinician.

Omega-3 fatty acids

Omega-3s (EPA and DHA from fish oil) support cardiovascular health mainly through anti-inflammatory and triglyceride-lowering effects, not fibrinolysis. The evidence here is genuinely mixed: a large Cochrane review found that increasing omega-3 (EPA and DHA) from supplements has little or no effect on cardiovascular mortality or events, even though major bodies still encourage eating 1–2 servings of oily fish per week. Omega-3 is a reasonable complement to a heart-healthy routine, but it is not a like-for-like substitute for a fibrinolytic enzyme.

6. How to choose — and where nattokinase fits

Weighing these options comes down to 2 questions: how strong is the evidence, and how well is the product made? On the first, nattokinase stands out among the group — it is the only one of these five supported by multiple randomized human trials, including the meta-analysis of 6 studies that found a roughly 3.45 mmHg reduction in systolic blood pressure. Serrapeptase, lumbrokinase and bromelain each have narrower or more specialized evidence, while aspirin and omega-3 have moved toward "case-by-case" territory.

On the second question, quality varies widely between brands, so specifics matter. BioAbsorb Nattokinase Enzyme delivers 100 mg (2000 FU) of nattokinase per capsule — consistent with the dose range used in the research — in a DRcaps delayed-release veggie capsule that protects the enzyme from stomach acid without the phthalates and plasticizers found in many enteric coatings. It is intentionally free of Vitamin K2, which allows longer-term dosing without the concerns tied to excess K2, and it is made in a Canadian GMP-certified, non-GMO facility with every batch third-party tested for potency, heavy metals and microbial contaminants. At a 180-capsule, 6-month supply for $49.87 — roughly $0.28 per day — it is designed as a simple once-daily option (1 capsule on an empty stomach) for readers who want the best-studied enzyme in a clean, verified form.

Whichever option you consider, one rule applies to all of them: because every supplement here can affect clotting, anyone taking a blood thinner such as warfarin, or living with a cardiovascular condition, should talk to a doctor before starting — a point that applies just as much to a 2000 FU nattokinase capsule as to 81 mg of aspirin.

Frequently Asked Questions

Is serrapeptase or nattokinase better for blood flow?

For circulatory support specifically, nattokinase has the stronger case: it has been studied in at least 6 randomized cardiovascular trials, whereas a systematic review found only about 9 mostly low-quality trials on serrapeptase's efficacy overall. Serrapeptase may still suit people focused on inflammation or swelling, but its fibrinolytic use in humans is not well established.

Is lumbrokinase stronger than nattokinase?

They are different rather than simply stronger or weaker. Lumbrokinase is fibrin-specific and most of its human research — including a 2025 meta-analysis — is as an add-on therapy in acute ischemic stroke, while nattokinase has more everyday preventive research such as blood-pressure trials. Lumbrokinase units (LKUs) also vary by manufacturer, making products harder to compare.

Can I take nattokinase and these alternatives together?

Combining 2 or more agents that affect clotting can add up, and a 2026 review specifically warns that bromelain may increase bleeding risk alongside anticoagulant or antiplatelet drugs. Stacking fibrinolytic supplements is not something to improvise — it should only be done under the guidance of a healthcare provider.

Is nattokinase just a natural version of aspirin?

Not exactly. Aspirin works by blocking platelets, while nattokinase works by breaking down fibrin, so they act on 2 different parts of the clotting process. That difference is one reason the 2022 USPSTF pullback on aspirin for primary prevention in adults 60 and older does not automatically apply to enzyme options.

How much nattokinase should I take?

Most studied benefits cluster around 2000 FU of enzyme activity per day, which is why many supplements — including BioAbsorb's 100 mg (2000 FU) capsule — are standardized to that amount. Our nattokinase dosage guide covers the studied dose range and timing in more detail. Because individual needs and medication interactions differ, confirm your dose with a clinician, especially if you are managing a cardiovascular condition.

Does whole natto count as an alternative?

Eating natto does provide nattokinase along with other nutrients, but the enzyme content of food varies and can be hard to quantify, whereas a standardized capsule delivers a consistent 2000 FU. For most people outside Japan, a measured supplement is a more reliable way to get a research-relevant dose than diet alone.

Conclusion

Several supplements are "similar to nattokinase," but similarity is not the same as equivalence: among serrapeptase, lumbrokinase, bromelain, aspirin and omega-3, nattokinase remains the only option backed by multiple randomized human trials, including one meta-analysis of 6 studies. If you want the best-studied fibrinolytic enzyme in a clean, third-party-tested form, explore BioAbsorb's 2000 FU Nattokinase Enzyme — and talk with your doctor before starting any new supplement.

Research References

1. Nattokinase: A Promising Alternative in Prevention and Treatment of Cardiovascular Diseases. Biomarker Insights, Vol. 13 (2018). Review summarizing nattokinase's fibrinolytic, antihypertensive, anti-atherosclerotic and anti-platelet actions; supports its use as the fibrinolytic benchmark for comparison.
2. Nattokinase Supplementation and Cardiovascular Risk Factors: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Reviews in Cardiovascular Medicine, Vol. 24, No. 8 (2023). Meta-analysis of 6 RCTs (546 participants) finding nattokinase reduced systolic blood pressure by about 3.45 mmHg; underpins the claim that it has the strongest human evidence of the group.
3. Thrombolytic Enzymes of Microbial Origin: A Review. International Journal of Molecular Sciences, Vol. 22 (2021). Review of fibrinolytic enzymes from bacteria, fungi and algae; documents the bleeding risks of classical thrombolytics that motivate interest in gentler enzyme alternatives.
4. Serratiopeptidase: a systematic review of the existing evidence. International Journal of Surgery, Vol. 11, Issue 3 (2013). Found only about 9 mostly poor-methodology RCTs on serrapeptase's efficacy; supports the point that serrapeptase's evidence is thinner than nattokinase's.
5. Study of the fibrinolytic activity of serrapeptase and its in vitro thrombolytic effects. Brazilian Journal of Pharmaceutical Sciences, Vol. 58 (2022), article e201004. In-vitro study showing serrapeptase's fibrinolytic and thrombolytic activity while noting its clinical fibrinolytic use is unproven.
6. Therapeutic Potential of Lumbrokinase in Acute Ischemic Stroke: A Meta-Analysis of Efficacy and Safety. Therapeutics and Clinical Risk Management (2025). Meta-analysis showing lumbrokinase, as an adjunct to supportive care, improved neurological function in acute ischemic stroke; supports the fibrin-specific, adjunct-therapy profile described.
7. Potential health benefits of bromelain: a critical review of the current literature. Frontiers in Nutrition (2026). Critical review documenting bromelain's fibrinolytic and anti-platelet effects, its limited clinical evidence, and its bleeding-risk caution with anticoagulants.
8. Omega-3 Fatty Acids for the Primary and Secondary Prevention of Cardiovascular Disease. Cochrane Database of Systematic Reviews, Issue 7 (2018), Art. No. CD003177. Cochrane review finding that increasing long-chain omega-3 (EPA and DHA) has little or no effect on cardiovascular mortality or events; supports the point that omega-3 is not a fibrinolytic substitute and its preventive evidence is weak.
9. Aspirin Use to Prevent Cardiovascular Disease: Preventive Medication. U.S. Preventive Services Task Force (2022). Recommends against initiating low-dose aspirin for primary prevention in adults 60 and older and individualized decisions for ages 40–59; supports the "conventional options have narrowed" framing.

About the Author

David Kimbell is a health writer, digital entrepreneur and former aerospace engineer, based in Ottawa, Canada. He loves translating complex science into clear, actionable guidance for consumers seeking evidence-based solutions.

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Important Disclaimers

Medical Disclaimer: This article provides educational information only and is not intended as medical advice. Always consult with a qualified healthcare provider before starting any new supplement, especially if you have existing health conditions, take medications, or are pregnant or nursing.

FDA/Health Canada Statement: These statements have not been evaluated by the Food and Drug Administration or Health Canada. This product is not intended to diagnose, treat, cure, or prevent any disease.