Nattokinase questions - esp from users
My Lilah's HCM has progressed and she is now at risk for clots (and CHF). After posting a week or so ago, I started her on Natto. I rec'd a msg from the cardiologist saying it doesn't work so I'm hoping to hear from some of you that have used it. Specific questions are:
-If you've used it - for how long?
-Has you cat had any clots before or after starting Natto?
-Has anyone seen it lower their cat's blood pressure?
-Has anyone's vet checked VIN for info?
Any other info or experience (pos. or neg.) would be great.
Thanks very much!
- Hi Kristin
I am using nattokinase with two cats. One had a stroke/clot to the brain
and the other is because I feel she's at risk. I also have a cat on plavix.
My cardiologist doesn't recommend nattokinase but I've been using it for
years with Josh and Milli.
WHat did you cardiologist recommend for the clots? Mine gives aspirin and
[Non-text portions of this message have been removed]
- Hi Lyn,
Thanks for your reply. So, one of your kitties had a clot, started Natto, and hasn't had another for a couple of years? What made you decide to treat 2 w/Natto and 1 w/plavix?
When we saw cardio for routine echo recheck that's when significant progression was seen (more thickening and left atrium enlargement). But she also had increased vomiting, decreased appetite and a lot of blood in urine (she also has kidney disease) so he started her on a/b's for suspected infection and wanted to wait to start heart meds temporarily. He gave me a brief rundown on pimobendan as well as anti-clotting meds (re: those he said aspirin is probably the least effective, heparin/fragmin probably the most effective but extremely expensive and that most go w/plavix. But he added that a side effect is blood in urine for plavix and fragmin).
Next we saw internist and had abdominal u/s and no signs of infection, stones etc were seen. She had spoken to Cardio who strongly recommended starting pimobendan which we did. About 5 days later she had to have another echo to make sure pimo wasn't adversely affecting her heart (which apparently can happen in some cases of HCM). Our regular cardio was off-clinic so we had to see someone else. She had never heard of Nattokinase and strongly advised starting plavix and called in a compounded Rx. When I got home I reread my notes from earlier visit and was reminded of the blood in urine s/e. I'm not sure if 2nd cardio realized that was already an issue for Lilah or not but our regular cardio had his tech call to see how Lilah was doing when he returned and I told tech I wanted to start Natto. The tech called back and told me cardiologist said Natto doesn't work. So, before I call him directly I was hoping to get at least some anecdotal info from users like you b/c I know he doesn't approve. He is nationally known and extremely well-respected (I don't know if I can identify him here?) so I have a lot of confidence in him which makes me more insecure about treating against his recommendation.
I had another u/a and c&s done which still showed over 50 RBC (the highest amt) and no infection. B/C of Lilah's kidney disease she would be on a lowered dose of plavix. So, my concerns about plavix are:
1. It seems likely that bloody urine could get worse.
2. I read that there is no established minimum effective dose for cats so being on a reduced dose may not prevent a clot, esp since some still have clots on a full dose.
3. In the past w/unpleasant liquid meds, she refuses to swallow and lets it run out of her mouth so I probably won't even be able to consistently get it in her, plus I don't want to make her miserable.
I'm sure that's WAY more info than you were looking for but that's everything I know. Any additional thoughts, advice, etc are more than welcome!
--- In email@example.com, elfinmyst@... wrote:
> Hi Kristin
> I am using nattokinase with two cats. One had a stroke/clot to the brain
> and the other is because I feel she's at risk. I also have a cat on plavix.
> My cardiologist doesn't recommend nattokinase but I've been using it for
> years with Josh and Milli.
> WHat did you cardiologist recommend for the clots? Mine gives aspirin and
> _www.myfurkids.co.uk_ (http://www.myfurkids.co.uk/)
> [Non-text portions of this message have been removed]
- Hi Kristen
you wrote..''So, one of your kitties had a clot, started Natto, and hasn't
had another for a couple of years? What made you decide to treat 2 w/Natto
and 1 w/plavix?''
We aren't sure if Josh actually threw a clot, his symptoms were a sudden
violent fit. Josh had been diagnosed by ultrasound with HCM but there wasn't
clot risk at the time so we gave him the natto as a precaution. He didn't
see the cardiologist after his fit.
Trixi did throw a clot. That was diagnosed at the hospital and she started
plavix as recommended by the cardiologist at the time. She also started
aspirin but was violently sick on it so it was discontinued.
Milli, the cardiologist says isn't at risk of a clot and doesn't need
medication for it. But her heart is so poor we decided to start it anyway as a
precaution. It wasn't recommended by the cardiologist but by experience of
people on this forum.
If your cardio recommends plavix I would likely go with that choice.
Nattokinase does not prevent a clot happening in the first place where plavix
makes them less likely. Natto dissolves small clots which have formed as a
My own situation is best summed up as... if the vet recommends plavix I`d
go with that, if they recommend nothing I use nattokinase. Hope that helps:)
You could look at nattokinase in human studies to see how effective it is,
but there's nothing for cats.
[Non-text portions of this message have been removed]
- Since there are no documented studies that have revealed any results yet on Plavix, I, too, would like to hear from any forum members who have a cat on Plavix that was diagnosed via ultrasound/ echocardiogram with "smoke" and if the Plavix seems working for you to reduce the "smoke" or prevent clots. For example, " no clots for 2 years, no noticeable help at all, vets says can't see smoke or clots any more?" I know every animal is individual but sometimes vets don't do a great job of conveying their field experience with these treatment protocols and there isn't much written info out there yet.
For the forum members who don't know what "smoke" is, it is the "swirling" that is seen on an echocardiogram by the veterinarian. Apparently as the left atrium of the heart enlarges as the disease progresses, there in increasing risk of turbulence and arterial thrombosis with the increasing heart size. My vet calls it "sticky blood."
Here is a good article I found describing the various drugs prescribed by veterinarians to inhibit "the coagulation cascade or platelets" which can lead to feline aortic thromboembolism:
Another good article on HCM in general - http://www.newmanveterinary.com/felhcm.html
- Thanks for responding. Although your news is very disheartening to me, it will help me to possibly explore another option if the Lovenox also does not work for my cat Moe. I, too, am extremely frustrated by the lack of productive research concentrating on effective treatment protocols to prevent clotting in HCM cats. I am aware of the "Fatcat" study at Purdue, but results are not yet available on whether aspirin or Plavix is more effective in preventing additional clots in cats that have already had one. I guess the reason might be that it is so hard to find participants for the study as the first clot can be dire. Many people elect to put down the animal because treatment to see if the clot will resolve can be expensive and the chances for a reoccurring second clot at some point down the line are high. My cardiologist will be attending a meeting in June where she may get some additional information (hopefully) on this ongoing study.
Many cats are not responsive to either aspirin or Plavix and have to move on to Lovenox (Enoxaparin) or heparin to try to prevent clotting. Since this drug is expensive, many people elect not to use it. If our initial test shows that it is helping, we will continue to buy our Lovenox through a pharmacy in Canada where the cost is much reduced. We are fighting this HCM aggressively to the best of our ability working with a cardiologist that completed her PHD on Maine Coon cats with HCM in California. We are not rich by any means. I estimate that we have spent close to $10,000 since early January in echocardiograms, ultrasounds, blood tests, medications, rechecks. etc. and I'm not sure we're making any headway yet - but we are trying. If this doesn't work for Moe, I'm hoping the cardiologist can take some of our information into the research groups to which she belongs and find a solution for this horrible horrible genetic disease. Maybe it will help in the treatment of other cats down the line.
Bear with me a bit as I have a few questions that may help me have some future productive conversations with Moe's cardiologist on his next followup visits. Moe has just finished his fifth dose of Lovenox and his blood test yesterday revealed he is handling it well this time. We go in for another echo on Wednesday to see if the "smoke" or swirling seen on his last echo is reduced with the Lovenox. We are trying to prevent a first clot. Needless to say, my own cortisol levels are shooting through the roof with worry about his future prospects.
1. Was you cat placed on Lovenox after any test which revealed an impending clot? How old was your cat at the time and did he have secondary health conditions that impacted his treatment?
2. How long was your cat on Lovenox before the clot and stroke occurred? Can you remember what dose he was on? (Moe gets 7 units by shot under the skin every 12 hours - 10mg/0.1 ml - which is a very small dose).
3. I am assuming the clot/stroke was fatal or did you elect to put your cat down?
4. Was your cat also on any other medication at the same time as Lovenox/fragmin and what doses, etc.?
Any information from those who "have been there and done that" is especially helpful. Thank you all for taking your time to reply. It is deeply appreciated.
On Apr 24, 2012, at 9:42 AM, jenzcritters wrote:
> I had my cat on lovenox/fragmin (almost exactly the same and we alternated based on availability) but it didn't work. He got a clot in his heart then had a stroke.
> In humans, we always use coumadin for this and feel that lovenox, fragmin and heparin don't work well. We use plavix for prevention too but feel coumadin is the best. We tried my boy on coumadin but blood levels were all over the place. I found out too late that the blood specimens were not being done properly. Sigh. The blood level used is prothrombin. It is a blue top tube and MUST be filled to the line. They didn't know this and the lab would run the samples (another medical error since the tubes should have been refused as unsatisfactory). It was too late for my boy but I did educate the hospital staff and lab staff about their error.
> My mom has been on coumadin to prevent clots in her enlarged left atrium for many years.
> So sad that there really aren't good studies out there about what to do. And I really wish there were good studies on the natto. Seems to me you could do a simple data base for cats with a certain degree of HCM then just keep track on nothing vs natto vs coumadin vs heparin vs LMW (lovenox), vs plavix vs aspirin. It frustrates me that no one seems willing to do much research like this with cats.
In answer to your questions. 1. Truman was only a year and a half old when diagnosed with HCM. The left atrium was dilated so he was placed on fragmin (another version of low molecular weight heparin comparable to lovenox) immediately. We switched to lovenox a few months later due to availability and cost but the Cardiologist considered them interchangeable. He had no other secondary health conditions. 2. I do not remember the dose. He was on the injections for just over a year when the clot occurred. I never missed doses. 3. The stroke was not fatal immediately. He stopped breathing but I performed CPR on the way to the vet and we intubated him and rescuscitated him. I took him home that night with the breathing tube but was able to remove it in the middle of the night. After the stroke, he had a stiff legged walk and was blind. He lived 3 more weeks during which we added the coumadin but he passed away in my bed with me. 4. Truman died in 2004 so I don't remember his meds off hand. He was on 14 doses of medicine per day. Of course he got several doses of lasix, etc. He also got spironolactone and a calcium channel blocker.
I spent much more than $10,000.00 on my boy. I would have sold my house and moved to the trailer park if it would have saved him. He needed a heart transplant but no one would do that for a kitty.
My 7 year old mixed Maine Coon, Moe, has started back on Lovenox for the second time. He has been on it now for 2 weeks and seems to be handling it well (this time). The first week he was on it we did a morning and evening injection of 7 units under the skin (the bottle says enoxaparin 10mg/0.1 ml/#30 0.1 ml). We started the injections on a Sunday when we were home and could watch him. Monday morning we took him in to have a blood test (according to our invoice it is a PCV + Total Solids STAT) to see if there were any abnormal values. The blood test is relatively inexpensive (~ $37) and we do it with a "nurse only" appointment so avoid the normally high costs of his progress evaluations and tests done with the cardiologist. We did another PCV blood test on Wednesday morning in addition to an ultrasound to see if the Lovenox was working. The blood tests revealed normal values and fortunately, the smoke seems to be better and the clot that was forming is now gone. Looks like Lovenox is working for Moe will he be on Lovenox for the remainder of his life. We will do another full blown follow-up evaluation again in about a week or so. The cardiologist is being EXTREMELY conservative this time for some very specific reasons (which you will see below). In addition to the Lovenox, Moe ges porassium gluconate 3 times daily ( 2 mEQ tablets - 1 1/2 pills morning and evening, 1 pill mid afternoon). He also gets Atenolol (25 mg tablets - 1/4 tablet every 12 hours) and furosemide (12.5 mg tables - 1 tablet - morning, midday, and evening). He is not on Plavix or aspirin (this time) and I honestly don't know if the cardiologist will eventually add back Plavix at some point down the road. I will ask her on Moe's next follow-up.
Our first experience trying Lovenox back in mid February was not so great. Prior to going on Lovenox for the first time, Moe was on approximately the same does of potassium gluconate, furosemide, and atenolol as listed above. In addition, he was getting 1/4 tablet of Plavix (75 mg tablets) every 24 hours, and 1/4 tablet of baby aspirin once a day (Mondays, Wednesday, and Fridays only). Based on his ultrasounds and increasing smoke, the cardiologist decided to add Lovenox to his regimen too. I was concerned because Plavix, aspirin, and Lovenox are all blood thinners but I kept my mouth shut deferring to greater experience.
We started the first doses of Lovenox on the weekend and stayed home to watch how he was doing. He was getting a morning shot and evening shot (same dose as above) only. The first day we didn't notice anything dramatic but did note that Moe seemed to be "ground bound" not wanting to climb up or down on anything. He seemed very quiet and often had a faraway look in his eyes - almost as if he was concentrating intently on something. He seemed lethargic. He did not want to eat and stopped drinking.
By the second day (his third shot given in the morning) he seemed even more lethargic. We gave the fourth shot in the evening before going to bed. In the middle of the night, he started to "dry retch", fell over onto his nose, and was as limp as a rag. We grabbed him and headed to the emergency clinic.
Good thing we did has his blood values had plummeted (full blood test taken before starting Lovenox was totally normal) and Moe was given an emergency blood transfusion and kept in the hospital for 3 days on fluids, etc. Fortunately, Moe was not in congestive heart failure at the time as the furosemide he was taking had emptied his lungs of fluid and his not drinking had made him dehydrated so they were able to slowly add back fluids into his system. The veterinarians said that he would have died had we not brought him in and it was miraculous that he made it even with the blood transfusion because his blood values had plummeted so low. Moe had bled internally in his stomach and the veterinarians gave us no reason as to what triggered the bleeding but I can't help believe it was the cumulative effect of all three thinners given at the same time (aspirin, Lovenox, Plavix). His full panel blood test taken immediately before adding the Lovenox was totally NORMAL.
I'm not sure what happened here. Maybe the cardiologist forgot he was on a triple dose of blood thinners and didn't look back in the file to double check? Maybe Moe's experience was different than all kitties treated in a similar scenario before? Maybe this was the first time a cat was treated there with all 3 meds/doses? We didn't blame the cardiologist and forged ahead. However, we almost lost the beautiful kitty we so dearly love and put him through a hospital stay that was pretty stressful and expensive ($3500). I now make sure during EVERY follow-up visit that the cardiologist READS the list of medicines Moe has been prescribed and is currently on at the time of the vet visit. I insist on written instructions for every med change and we go over it together before I leave the hospital.
Our total vet costs for Moe since January of this year have been $10,000 plus (includes tests, meds, vet consults). We don't regret a penny on this beautiful cat but it has been frustrating that the treatment protocols for HCM seem to be hit and miss. There's not much out there in terms of double blind tests and studies on cats to determine what works best for what set of conditions. I guess every animal is different. Our cardiologist indicated it is difficult to get funding for the studies and many people elect not to invest the money in the testing/treatment of "a cat."
Moe was started back on Lovenox just recently because it appeared the combination of Plavix and aspirin alone weren't working for him to reduce the turbulence and clotting factor. He needed something and we really didn't have any options. NOTE: Before we started Lovenox for the second time, we took him OFF both Plavix and aspirin and put him on sucralfate (100 mg/ml - give 2.5 mls every 8 hours) and omeprazole (20 mg capsules - 1 capsule every 24 hours) for 2 weeks prior to starting the second round of Lovenox. This was to heal any ulcers that may have caused the internal bleeding. He is still currently taking the omeprazole and sulcrafate until the bottles are empty.
I would highly recommend checking your kitties blood a day or so at the most after you start the Lovenox to see if he's doing well. Hind sight is 20-20 and if I had it to do all over again..... A low cost blood test could save you a $3500 hospital stay. It would be worth a discussion with your vet.
Moe seems to be doing quite well now but we are taking it day by day and testing, testing, periodically. Ask lots of questions. Hope this helps. Feel free to email with any additional questions.
On May 1, 2012, at 1:36 PM, olsoncleaning@... wrote:
> My 4yr old boy was diagnosed about a year ago with severe HCM. They put him on atenolol and plavix. They saw clots and the turbulence in this left chamber. On his second echo, the clots and the turbulence were gone. On his third echo, they still don't see any turbulence but do see a clot adhering to the lining of his heart. So, now they're going to put him on lovenox. His HCM has not really progressed, just a slight thickening of the wall, which the cardiologist says is a good thing. The only other thing that's going on with my boy is that he's had diahrrea for several months. My vet is just starting to work on solving that, but I'm a bit concerned that the Plavix might be causing it. I've read that Plavix can cause stomach issues on humans, so you can only imagine what's happening to my little eight pound boy.
> --- In firstname.lastname@example.org, Mary McKee <marylmckee@...> wrote:
>> Since there are no documented studies that have revealed any results yet on Plavix, I, too, would like ttotao hear from any forum members who have a cat on Plavix that was diagnosed via ultrasound/ echocardiogram with "smoke" and if the Plavix seems working for you to reduce the "smoke" or prevent clots. For example, " no clots for 2 years, no noticeable help at all, vets says can't see smoke or clots any more?" I know every animal is individual but sometimes vets don't do a great job of conveying their field experience with these treatment protocols and there isn't much written info out there yet.
>> For the forum members who don't know what "smoke" is, it is the "swirling" that is seen on an echocardiogram by the veterinarian. Apparently as the left atrium of the heart enlarges as the disease progresses, there in increasing risk of turbulence and arterial thrombosis with the increasing heart size. My vet calls it "sticky blood."
>> Here is a good article I found describing the various drugs prescribed by veterinarians to inhibit "the coagulation cascade or platelets" which can lead to feline aortic thromboembolism:
>> Another good article on HCM in general - http://www.newmanveterinary.com/felhcm.html