1). Ngā tūroro whiu

Ko te whiu cardioembolic he whiu ischemic i puta mai i te whakahekenga o ngā emboli cardiogenic me te embolizing o ngā uaua roro e rite ana, e 14% ki te 30% o ngā whiu ischemic katoa. I roto i ēnei, neke atu i te 79% o ngā whiu cardioembolic katoa e pā ana ki te atrial fibrillation, ā, he kino ake ngā whiu cardioembolic, ā, me tautuhi wawe me te wawao kaha. Hei aromatawai i te mōrearea thrombosis me te maimoatanga anticoagulation o ngā tūroro, me te maimoatanga anticoagulation haumanu me whakamahi i ngā tohu coagulation hei aromatawai i te pānga anticoagulation me te rongoā anticoagulation tika hei aukati i te toto.

Ko te mōrearea nui rawa atu i roto i ngā tūroro e pāngia ana e te atrial fibrillation ko te thrombosis arterial, inā koa ko te cerebral embolism. Ngā taunakitanga ārai toto mō te infarction cerebral i muri mai i te atrial fibrillation:
1. Kāore i te tūtohutia kia whakamahia tonutia ngā rongoā ārai toto mō ngā tūroro e pāngia ana e te mate roro whakapeka.
2. Mō ngā tūroro e rongoatia ana ki te thrombolysis, kāore i te tūtohutia kia whakamahia ngā rongoā ārai toto i roto i ngā haora 24.
3. Mena kāore he ārai pēnei i te toto totoka, te mate kino o te ate me te whatukuhu, te toto toto >180/100mmHg, me ētahi atu, ka taea te whakaaro ko ēnei āhuatanga he whakamahinga whiriwhiri o ngā rongoā ārai toto:
(1) Ko ngā tūroro e pāngia ana e te mate ngakau (pērā i te takirere horihori, te fibrillation atrial, te mate ngakau me te mural thrombus, te thrombosis atrial maui, me ētahi atu) ka pāngia e te whiu anō.
(2) Ngā tūroro e pāngia ana e te whiu ischemic me te korenga o te pūmua C, te korenga o te pūmua S, te ātete pūmua C kaha me ētahi atu tūroro thromboprone; ngā tūroro e whai tohu ana i te aneurysm dissecting extracranial; ngā tūroro e whai tohu ana i te stenosis o te uaua intracranial me te intracranial.
(3) Ka taea e ngā tūroro e takoto ana i runga i te moenga me te mate roro ngoikore te whakamahi i te heparin iti te horopeta, te horopeta rānei e rite ana o te LMWH hei ārai i te thrombosis uaua hohonu me te embolism pūkahukahu.

2). Te uara o te aroturuki i te taupū toto totoka ina whakamahia ngā rongoā anticoagulant

• PT: He pai te mahi INR a te taiwhanga, ā, ka taea te whakamahi hei ārahi i te whakarerekētanga horopeta o te warfarin; aromatawai i te mōrearea toto o te rivaroxaban me te edoxaban.
• APTT: Ka taea te whakamahi hei aromatawai i te whai huatanga me te haumaru o te heparin kore-wāhanga (ngā horopeta taurite) me te aromatawai kounga i te mōrearea toto o te dabigatran.
• TT: He tairongo ki te dabigatran, e whakamahia ana hei tirotiro i te toenga o te dabigatran i roto i te toto.
• D-Dimer/FDP: Ka taea te whakamahi hei aromatawai i te pānga rongoā o ngā rongoā ārai toto pēnei i te warfarin me te heparin; me te aromatawai i te pānga rongoā o ngā rongoā whakaheke toto pēnei i te urokinase, streptokinase, me te alteplase.
• AT-III: Ka taea te whakamahi hei ārahi i ngā pānga rongoā o te heparin, te heparin taumaha ngota iti, me te fondaparinux, me te tohu mēnā me huri ngā rongoā ārai toto i roto i te mahi haumanu.

3). Te ārai i te toto i mua atu, ā, i muri i te whakapūtanga o te uaua o te atrial fibrillation

He tūponotanga kei te pāngia te toto toto i te wā e whakamahia ana te cardioversion o te atrial fibrillation, ā, mā te rongoā anticoagulation tika ka taea te whakaiti i te tūponotanga o te thromboembolism. Mō ngā tūroro he koretake te toto me te atrial fibrillation e hiahia ana kia tere te cardioversion, kaua te tīmatanga o te anticoagulation e whakaroa i te cardioversion. Mena kāore he ārai, me whakamahi wawe tonu te heparin, te heparin taumaha ngota iti rānei, te NOAC rānei, ā, me mahi te cardioversion i te wā kotahi.