Lumbrokinase
A group of fibrinolytic enzymes extracted from earthworms, used in China and parts of Asia as an adjunct for stroke, angina, and circulatory disorders; potent in the laboratory but with limited Western clinical evidence.
At a Glance
- Best known for
- Potent fibrinolytic and anticoagulant activity, Studied in China for ischemic stroke and angina, Reduces fibrinogen and blood viscosity
- Evidence
- Preliminary
- Typical dose
- 20 mg (1 capsule) 1–2x daily on empty stomach
- Type
- Compound
What is Lumbrokinase?
Lumbrokinase is the collective name for a group of fibrin-dissolving enzymes extracted from earthworms, mainly Lumbricus rubellus. Earthworms (dilong, 'earth dragon') have been used in Traditional Chinese Medicine for over 2,000 years for 'blood stasis', fever, and paralysis after stroke. In 1991 Japanese researchers isolated the fibrinolytic proteases from Lumbricus rubellus, and Chinese and Korean companies developed purified oral products (Boluoke, Lumbrokinase capsules) that are approved as prescription or hospital drugs in China and Korea for ischemic stroke and cardiovascular disease. In North America and Europe it is sold as a dietary supplement, where it is popular with practitioners treating hypercoagulability, chronic infections, and Lyme disease.
Known Health Benefits
How It Works
Lumbrokinase enzymes degrade fibrin directly (like plasmin) and also activate plasminogen into plasmin, so they both dissolve existing fibrin and amplify the body's own fibrinolytic cascade. They reduce fibrinogen levels, decrease platelet aggregation, lower blood viscosity, and increase tissue plasminogen activator while reducing plasminogen activator inhibitor-1. Unlike nattokinase, the enzymes appear to be relatively fibrin-specific, degrading fibrin more readily than fibrinogen, which may explain the comparatively low bleeding rates reported in Chinese trials. Laboratory studies show lumbrokinase can also degrade the fibrin and protein components of bacterial biofilms, which is the rationale for its use in chronic infection protocols, though this has not been tested in humans. Animal studies suggest anti-ischemic and anti-platelet effects in the brain and heart.
What Research Says
Most clinical data come from China and Korea and are not readily accessible or of uniformly high quality. A 2013 randomized, double-blind trial in Chinese patients with stable angina (published in the American Journal of Chinese Medicine) found oral lumbrokinase reduced angina attack frequency and improved exercise tolerance compared with placebo over 2 months. A 2008 Chinese multicenter trial of 310 ischemic stroke patients reported improved neurological outcomes with lumbrokinase added to standard care, and a 2000 Clinical Hemorheology study documented reduced fibrinogen and increased tPA after treatment of cerebral infarction. Korean studies have reported reduced carotid intima-media thickness and improved blood flow. A 2016 Indonesian study of DLBS1033 (an Eisenia fetida enzyme product) showed reduced fibrinogen in healthy volunteers. Systematic reviews of Chinese trials conclude lumbrokinase likely benefits ischemic stroke recovery but note poor methodological quality and risk of bias. There are no large Western RCTs, no outcome trials for prevention, and no human trials for biofilm or Lyme-related claims.
Active Compounds
A family of six or more serine proteases (earthworm fibrinolytic enzymes, EFE; also called e-PA or DLBS1033) isolated from Lumbricus rubellus or Eisenia fetida
Forms & Bioavailability
Lumbrokinase enzymes are proteins but are absorbed intact across the intestine to a degree, likely via transcytosis; enteric coating protects them from stomach acid and is standard in quality products. Fibrinolytic activity in blood peaks around 2 hours after dosing and persists for several hours; effects on fibrinogen accumulate over days to weeks. It should be taken on an empty stomach at least 30 minutes before food. Products vary widely in enzyme activity, and units of measurement are not standardized between manufacturers.
Dosage Guidance
| Use Case | Dosage |
|---|---|
| Circulatory / fibrinolytic support | 20 mg (1 capsule) 1–2x daily on empty stomach |
| Hypercoagulability (practitioner-guided) | 20–40 mg 2–3x daily |
| Chinese prescription use (stroke/angina) | 400,000–600,000 units 3x daily |
| Biofilm protocols (unproven) | 20 mg 2x daily between meals |
Always consult a healthcare provider for personalized dosing.
Natural Food Sources
- Not found in food; extracted from earthworms
- Dried earthworm (dilong) is used in Chinese herbal decoctions but contains variable enzyme activity
Potential Side Effects
Bleeding or bruising; stomach upset, nausea, diarrhea; headache; rare allergic reactions; theoretical risk of hemorrhagic transformation in stroke
Who Should Avoid It
- Anticoagulant or antiplatelet therapy without medical supervision
- Bleeding disorders, active ulcer, recent hemorrhagic stroke, or planned surgery (stop 2 weeks before)
- Pregnancy and breastfeeding (no safety data)
- Severe liver disease (impaired clotting factor synthesis)
- Allergy to earthworm or shellfish-type proteins (theoretical)
Pregnancy & Lactation
Avoid. There are no safety data, and the anticoagulant effect poses bleeding risks during pregnancy, delivery, and the postpartum period.
Known Drug Interactions
Additive bleeding risk with warfarin, DOACs, heparin, aspirin, clopidogrel, NSAIDs, fish oil, ginkgo, and nattokinase; may enhance antihypertensive effects; theoretical interaction with thrombolytic drugs
Evidence Classification
Based on in vitro studies, animal models, pilot trials, or traditional use documentation. Clinical evidence is limited.
Frequently Asked Questions
How does lumbrokinase differ from nattokinase?
Both dissolve fibrin, but lumbrokinase is considerably more potent per milligram, is more fibrin-specific (less effect on fibrinogen), and both degrades fibrin directly and activates plasminogen. Nattokinase has more accessible Western trials, mainly for blood pressure. Lumbrokinase is used as a drug in China for stroke. Some practitioners prefer lumbrokinase for hypercoagulable states; neither has outcome trials in Western populations.
Is it safe to take with aspirin or blood thinners?
Not without supervision. Lumbrokinase adds to bleeding risk from any anticoagulant or antiplatelet drug. Some practitioners do combine them with monitoring, but doing so on your own is unwise. If you are on a blood thinner, discuss it with your prescriber before starting.
Does it break down biofilms?
In laboratory dishes, lumbrokinase degrades the fibrin and protein matrix that bacteria use to build biofilms, and it is widely used in Lyme and chronic infection protocols for this reason. There are no human studies showing this translates into clearing infections. Treat this as a theoretical use.
How do I judge product quality?
Enzyme activity, not milligrams, determines potency, but there is no universal unit; different brands report different units that cannot be compared directly. Choose a manufacturer that states enzyme activity per capsule, uses enteric coating, and has independent testing. Boluoke is the most studied brand name.
References
- A novel fibrinolytic enzyme extracted from the earthworm, Lumbricus rubellus. Mihara H, Sumi H, Yoneta T, et al.. Jpn J Physiol (1991)
- Oral lumbrokinase for the treatment of patients with stable angina: a randomized, double-blind, placebo-controlled trial. Cao YJ, Zhang X, Wang WH, et al.. Am J Chin Med (2013)
- Changes in coagulation and tissue plasminogen activator after the treatment of cerebral infarction with lumbrokinase. Jin L, Jin H, Zhang G, Xu G. Clin Hemorheol Microcirc (2000)
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