1). Nā maʻi hahau

ʻO ka hahau Cardioembolic kahi hahau ischemic i hoʻokumu ʻia e ka hoʻokahe ʻana o ka emboli cardiogenic a me ka embolizing ʻana i nā aʻa lolo e pili ana, e helu ana no 14% a 30% o nā hahau ischemic āpau. I waena o lākou, ʻoi aku ka nui o ka hahau e pili ana i ka atrial fibrillation ma mua o 79% o nā hahau cardioembolic āpau, a ʻoi aku ka koʻikoʻi o nā hahau cardioembolic, a pono e ʻike mua ʻia a hoʻokomo ikaika ʻia. No ka loiloi ʻana i ka pilikia thrombosis a me ka mālama ʻana i ka anticoagulation o nā maʻi, a me ka mālama ʻana i ka anticoagulation, pono e hoʻohana i nā ʻōkuhi coagulation e loiloi i ka hopena anticoagulation a me ka lāʻau anticoagulation pololei e pale aku i ke kahe ʻana o ke koko.

ʻO ka pilikia nui loa i nā poʻe maʻi me ka atrial fibrillation ʻo ia ka thrombosis arterial, ʻoi aku hoʻi ka cerebral embolism. Nā ʻōlelo aʻoaʻo Anticoagulation no ka cerebral infarction ma muli o ka atrial fibrillation:
1. ʻAʻole ʻōlelo ʻia ka hoʻohana mau ʻana i nā anticoagulants no nā maʻi me ka infarction cerebral acute.
2. I nā poʻe maʻi i mālama ʻia me ka thrombolysis, ʻaʻole ia e ʻōlelo ʻia e hoʻohana i nā anticoagulants i loko o 24 mau hola.
3. Inā ʻaʻohe contraindications e like me ke ʻano kahe koko, nā maʻi ate a me nā puʻupaʻa koʻikoʻi, ke koko >180/100mmHg, a pēlā aku, hiki ke manaʻo ʻia nā kūlana aʻe he hoʻohana koho ʻana i nā anticoagulants:
(1) ʻO nā maʻi me ka infarction cardiac (e like me ka valve artificial, atrial fibrillation, myocardial infarction me ka mural thrombus, hema atrial thrombosis, a me nā mea ʻē aʻe) e maʻalahi i ka hahau hou ʻana.
(2) Nā maʻi me ka hahau ischemic i hele pū ʻia me ka nele o ka protein C, ka nele o ka protein S, ke kū'ē ʻana o ka protein C ikaika a me nā maʻi thromboprone ʻē aʻe; nā maʻi me ka symptomatic extracranial dissecting aneurysm; nā maʻi me ka intracranial a me ka intracranial artery stenosis.
(3) Hiki i nā poʻe maʻi me ka infarction cerebral ke hoʻohana i ka heparin haʻahaʻa a i ʻole ka nui like o LMWH e pale aku ai i ka thrombosis vein hohonu a me ka embolism pulmonary.

2). ʻO ka waiwai o ka nānā ʻana i ka helu coagulation i ka wā e hoʻohana ʻia ai nā lāʻau anticoagulant

• PT: Maikaʻi ka hana INR o ka hale hana a hiki ke hoʻohana ʻia e alakaʻi i ka hoʻoponopono ʻana i ka nui o ka warfarin; e loiloi i ka pilikia o ke kahe koko o rivaroxaban a me edoxaban.
• APTT: Hiki ke hoʻohana ʻia e loiloi i ka pono a me ka palekana o (nā mahele kaulike) heparin unfractionated a e loiloi pono i ka pilikia o ke kahe koko o dabigatran.
• TT: Pilikia i ka dabigatran, hoʻohana ʻia e hōʻoia i ke koena dabigatran i loko o ke koko.
• D-Dimer/FDP: Hiki ke hoʻohana ʻia e loiloi i ka hopena therapeutic o nā lāʻau anticoagulant e like me warfarin a me heparin; a e loiloi i ka hopena therapeutic o nā lāʻau thrombolytic e like me urokinase, streptokinase, a me alteplase.
• AT-III: Hiki ke hoʻohana ʻia e alakaʻi i nā hopena lāʻau lapaʻau o ka heparin, ka heparin kaumaha molekala haʻahaʻa, a me ka fondaparinux, a e hōʻike inā pono e hoʻololi i nā anticoagulants i ka hana lapaʻau.

3). ʻO ka Anticoagulation ma mua a ma hope o ka cardioversion o ka atrial fibrillation

Aia kahi pilikia o ka thromboembolism i ka wā o ka cardioversion o ka atrial fibrillation, a hiki i ka lāʻau anticoagulation kūpono ke hōʻemi i ka pilikia o ka thromboembolism. No nā poʻe maʻi hemodynamically unstable me ka atrial fibrillation e koi ana i ka cardioversion wikiwiki, ʻaʻole pono e hoʻopaneʻe ka hoʻomaka ʻana o ka anticoagulation i ka cardioversion. Inā ʻaʻohe contraindication, pono e hoʻohana ʻia ka heparin a i ʻole ka heparin kaumaha molekala haʻahaʻa a i ʻole NOAC i ka wā hikiwawe loa, a pono e hana ʻia ka cardioversion i ka manawa like.