1).Cov neeg mob stroke

Cardioembolic stroke yog ib qho ischemic stroke tshwm sim los ntawm cardiogenic emboli shedding thiab embolizing cerebral hlab ntsha, accounting rau 14% mus rau 30% ntawm tag nrho cov ischemic strokes.Ntawm lawv, atrial fibrillation-txog mob stroke muaj ntau dua 79% ntawm tag nrho cov mob stroke cardioembolic, thiab cardioembolic strokes loj dua, thiab yuav tsum tau txheeb xyuas ntxov thiab nquag cuam tshuam.Txhawm rau ntsuas qhov kev pheej hmoo ntawm thrombosis thiab kev kho mob anticoagulation ntawm cov neeg mob, thiab kev kho mob anticoagulation yuav tsum tau siv cov ntsuas coagulation los ntsuas cov nyhuv anticoagulation thiab cov tshuaj tiv thaiv kev tiv thaiv kom tsis txhob los ntshav.

Qhov kev pheej hmoo loj tshaj plaws hauv cov neeg mob atrial fibrillation yog arterial thrombosis, tshwj xeeb tshaj yog cerebral embolism.Anticoagulation pom zoo rau cerebral infarction theem nrab rau atrial fibrillation:
1. Kev siv tam sim ntawd ntawm cov tshuaj tiv thaiv coagulants tsis pom zoo rau cov neeg mob uas mob cerebral infarction.
2. Hauv cov neeg mob kho nrog thrombolysis, feem ntau tsis pom zoo kom siv cov tshuaj anticoagulants hauv 24 teev.
3. Yog tias tsis muaj contraindications xws li los ntshav, mob siab thiab raum mob, ntshav siab> 180/100mmHg, thiab lwm yam., cov xwm txheej hauv qab no tuaj yeem txiav txim siab xaiv siv cov tshuaj tiv thaiv coagulants:
(1) Cov neeg mob uas muaj plawv infarction (xws li dag lub plawv, atrial fibrillation, myocardial infarction nrog mural thrombus, sab laug atrial thrombosis, thiab lwm yam) yog cov nquag mob stroke.
(2) Cov neeg mob uas muaj ischemic stroke nrog cov protein C tsis txaus, protein S tsis muaj peev xwm, cov protein C tsis muaj zog thiab lwm cov neeg mob thromboprone;cov neeg mob uas muaj cov tsos mob extracranial dissecting aneurysm;Cov neeg mob uas muaj intracranial thiab intracranial artery stenosis.
(3) Cov neeg mob Bedridden uas muaj lub paj hlwb infarction tuaj yeem siv tshuaj heparin qis lossis sib txuas ntawm LMWH txhawm rau tiv thaiv cov hlab ntsha sib sib zog nqus thiab pulmonary embolism.

2).Tus nqi ntawm coagulation index xyuas thaum siv tshuaj anticoagulant

• PT: Lub chaw soj ntsuam INR qhov kev ua tau zoo thiab tuaj yeem siv los coj kev hloov koob tshuaj ntawm warfarin;ntsuam xyuas qhov txaus ntshai los ntshav ntawm rivaroxaban thiab edoxaban.
• APTT: tuaj yeem siv los ntsuas qhov ua tau zoo thiab kev nyab xeeb ntawm (ntau npaum li cas) tsis muaj cov tshuaj heparin thiab ntsuas qhov ua tau zoo ntawm kev pheej hmoo los ntshav ntawm dabigatran.
• TT: rhiab heev rau dabigatran, siv los txheeb xyuas qhov seem dabigatran hauv cov ntshav.
• D-Dimer/FDP: Nws tuaj yeem siv los ntsuas qhov kev kho mob ntawm cov tshuaj tiv thaiv coagulant xws li warfarin thiab heparin;thiab soj ntsuam cov kev kho mob ntawm cov tshuaj thrombolytic xws li urokinase, streptokinase, thiab alteplase.
• AT-III: Nws tuaj yeem siv los coj cov tshuaj muaj txiaj ntsig ntawm heparin, qis molecular hnyav heparin, thiab fondaparinux, thiab qhia seb puas tsim nyog los hloov cov tshuaj tiv thaiv kab mob hauv kev kho mob.

3).Anticoagulation ua ntej thiab tom qab cardioversion ntawm atrial fibrillation

Muaj kev pheej hmoo ntawm thromboembolism thaum lub sij hawm cardioversion ntawm atrial fibrillation, thiab kev kho mob anticoagulation tsim nyog tuaj yeem txo qhov kev pheej hmoo ntawm thromboembolism.Rau cov neeg mob hemodynamically tsis ruaj khov nrog atrial fibrillation yuav tsum tau ceev cardioversion, qhov pib ntawm anticoagulation yuav tsum tsis txhob ncua cardioversion.Yog tias tsis muaj contraindications, heparin lossis qis molecular hnyav heparin lossis NOAC yuav tsum tau siv sai li sai tau, thiab cardioversion yuav tsum tau ua tib lub sijhawm.