Therefore, at the present time, warfarin should be preferred to DOACs in patients with ischemic, non- ischemic, or restrictive cardiomyopathy; ischemic stroke or TIA in sinus rhythm; and documented left atrial or LV thrombus. CLINICAL STATEMENTS AND GUIDELINES Kleindorfer 2. Thromboembolic complications represent a major therapeutic challenge in the LVAD population and can occur at any point after LVAD implantation, including the immediate postoperative period and the long-term follow-up.516 519 The pathophysiology associated with ischemic stroke in the LVAD popula- tion is complex, and the postulated underlying mech- anisms are different for early versus late strokes. In the immediate postoperative period, several surgical factors have been reported to possibly increase the risk. These factors include duration of cardiopul- monary bypass and the need for other associated surgeries (eg, coronary artery bypass surgery, valve Pump thrombosis, reduced pump speeds, venous thromboembolism, uncontrolled hypertension, and systemic infections have been associated with late strokes.518,519,521,522 A subopti- mal anticoagulation regimen, which includes either supratherapeutic or subtherapeutic INR and no aspi- rin use, has also been associated with increased risk of ischemic strokes. The use of DAPT compared with acetylsalicylic acid alone in addition to warfarin does not appear to affect the rates of ischemic stroke.523 Therefore, at the present time, the combination of warfarin and aspirin is the preferred regimen in pre- venting recurrent ischemic stroke. 3. LV noncompaction is a rare primary cardiomyopa- thy possibly caused by an arrest of normal embryo- genesis of the endocardium and mesocardium that leads to the formation of prominent trabeculations and deep intertrabecular recesses within the LV wall communicating with the cavity. 