Long-term thromboprophylaxis in metallic aortic valve prosthesis using oral nattokinase-A case report

Abstract

Oral anticoagulation with a vitamin K antagonist like warfarin is the standard of care for thromboprophylaxis after cardiac valve replacement. However warfarin requires strict monitoring of INR to avoid bleeding.Bleeding is a major concern with warfarin, particularly in those at high risk. Nattokinase is an enzyme obtained from natto, a cheese-like food made of soybeans fermented with Bacillus subtilis, which has been consumed as a traditional food in certain Asian countries for more than 2000 years.Recent research has demonstrated that nattokinase has potent fibrinolytic activity and antithrombotic action. We present a case of a 37-year-old male who had undergone aortic valve replacement using a metallic prosthetic valve for rheumatic heart disease associated severe aortic regurgitation and has been maintained on oral nattokinase therapy for prophylaxis against thromboembolic complications post cardiac wall replacement since the last 12 years.This case highlights the role of oral nattokinase for thromboprophylaxis in valve prosthesis and other prothrombotic states. This case report presents the first documented case where oral nattokinase has been successfully used for long-term thromboprophylaxis in metallic aortic valve prosthesis.: We present a case of a 37-year-old male who had undergone aortic valve replacement using a metallic prosthetic valve for rheumatic heart disease associated severe aortic regurgitation and has been maintained on oral nattokinase therapy for prophylaxis against thromboembolic complications post cardiac wall replacement since the last 12 years.This case highlights the role of oral nattokinase for thromboprophylaxis in valve prosthesis and other prothrombotic states. This case report presents the first documented case where oral nattokinase has been successfully used for long-term thromboprophylaxis in metallic aortic valve prosthesis.