1) Ndị ọrịa strok

Ọrịa strok obi (Cardioembolic stroke) bụ ọrịa strok obi (ischemic stroke) nke ọbara ọgbụgba akwara obi (cardiogenic embolism) na-akpata ma na-eme ka akwara ụbụrụ dị n'otu, nke ruru pasentị 14 ruo 30 nke ọrịa strok obi niile. N'ime ha, ọrịa strok obi metụtara atrial fibrillation na-akpata ihe karịrị pasentị 79 nke ọrịa strok obi niile, ọrịa strok obi (cardioembolic stroke) dịkwa njọ karịa, a kwesịkwara ịchọpụta ya n'oge ma tinye aka n'ọrụ. Iji nyochaa ihe egwu thrombosis na ọgwụgwọ anticoagulation nke ndị ọrịa, na ọgwụgwọ anticoagulation, ọ dị mkpa ka e jiri ihe ngosi coagulation chọpụta mmetụta anticoagulation na ọgwụ anticoagulation ziri ezi iji gbochie ọbara ọgbụgba.

Ihe kacha enye nsogbu n'ahụ ndị nwere atrial fibrillation bụ thrombosis akwara, ọkachasị cerebral embolism. Ndụmọdụ ndị na-egbochi coagulation maka infarction ụbụrụ nke sochiri atrial fibrillation:
1. A naghị atụ aro ka ndị ọrịa nwere nnukwu nsogbu ụbụrụ na-eji ọgwụ mgbochi ọbara eme ihe ozugbo.
2. N'ime ndị ọrịa a gwọrọ site na thrombolysis, a naghị atụ aro ka e jiri ọgwụ mgbochi ọbara mee ihe n'ime awa iri abụọ na anọ.
3. Ọ bụrụ na enweghị ihe mgbochi dịka ọbara ọgbụgba, ọrịa imeju na akụrụ siri ike, ọbara mgbali elu karịrị 180/100mmHg, wdg, enwere ike iwere ọnọdụ ndị a dị ka iji ọgwụ mgbochi afọ eme ihe n'ụzọ na-adịghị mma:
(1) Ndị ọrịa nwere nkụchi obi (dịka valvụ arụrụ arụ, nkụchi atrial fibrillation, nkụchi myocardial infarction nwere thrombus mural, thrombosis atrial left, wdg) na-enwekarị ọrịa strok ugboro ugboro.
(2) Ndị ọrịa nwere ọrịa strok ischemic nke nwere ụkọ protein C, enweghị protein S, iguzogide protein C na ndị ọrịa thromboprone ndị ọzọ; ndị ọrịa nwere aneurysm nke na-agbasa n'èzí cranial; ndị ọrịa nwere stenosis nke akwara intracranial na intracranial.
(3) Ndị ọrịa na-arịa ọrịa obi nwere nsogbu iku ume n'ime arịa ọbara nwere ike iji obere heparin ma ọ bụ dose LMWH kwekọrọ na ya iji gbochie thrombosis nke akwara miri emi na pulmonary embolism.

2). Uru nke nlekota coagulation index mgbe ejiri ọgwụ anticoagulants eme ihe

• PT: Arụmọrụ INR nke ụlọ nyocha ahụ dị mma ma enwere ike iji ya duzie mgbanwe dose nke warfarin; nyochaa ihe egwu ọbara ọgbụgba nke rivaroxaban na edoxaban.
• APTT: Enwere ike iji ya chọpụta irè na nchekwa nke heparin na-enweghị oke (ọnụọgụ dị n'etiti) yana iji chọpụta ihe egwu ọbara ọgbụgba nke dabigatran n'ụzọ dị mma.
• TT: Na-enwe mmetụta na dabigatran, nke a na-eji enyocha ihe fọdụrụ na dabigatran n'ọbara.
• D-Dimer/FDP: Enwere ike iji ya nyochaa mmetụta ọgwụgwọ nke ọgwụ mgbochi mkpali dịka warfarin na heparin; nakwa iji nyochaa mmetụta ọgwụgwọ nke ọgwụ thrombolytic dịka urokinase, streptokinase, na alteplase.
• AT-III: Enwere ike iji ya duzie mmetụta ọgwụ nke heparin, heparin dị obere n'ọbara, na fondaparinux, yana igosi ma ọ dị mkpa ịgbanwe ọgwụ mgbochi ọbara n'ọrụ ahụike.

3) Mgbochi ọbara ọgbụgba tupu na mgbe obi mgbawa nke atrial fibrillation gasịrị

E nwere ihe egwu nke thromboembolism n'oge obi mgbawa nke obi mgbawa, ọgwụgwọ anticoagulation kwesịrị ekwesị nwere ike ibelata ihe egwu nke thromboembolism. Maka ndị ọrịa hemodynamics na-anaghị akwụsi ike nke nwere atrial fibrillation nke chọrọ cardioversion ngwa ngwa, mmalite nke anticoagulation ekwesịghị igbu oge cardioversion. Ọ bụrụ na enweghị ihe mgbochi, a ga-eji heparin ma ọ bụ obere molekul heparin ma ọ bụ NOAC mee ihe ozugbo enwere ike, a ga-emekwa cardioversion n'otu oge ahụ.