A single-center retrospective study of anticoagulation with a DOAC in 52 patients for the treatment of LV thrombus found resolution of the thrombus in 86% of patients on follow-up echo- cardiography, but the study was too small to address embolic event rates.509 A larger retrospective analy- sis of 514 patients with identified LV thrombi from 3 centers and a median follow-up of 351 days com- pared 300 patients who received warfarin with 185 patients treated with DOAC and noted a higher rate of stroke or systemic embolism in the DOAC group (HR, 2.71 versus warfarin), although this difference was noted beyond the currently recommended duration of therapy for LV thrombi.513 4. Patients with reduced LV systolic function (LV EF <50%) in the setting of acute anterior MI are at the greatest risk of developing LV thrombus.514 The observed rate of LV thrombus in anterior MI was 24% in 1 series by cardiac MRI.505 The risk of stroke among patients with defined LV throm- bus has been reported to be as high as 9% to Therefore, for patients who have stroke or TIA in the context of anterior MI with reduced EF (ie, the cardiac population at the highest risk for CLINICAL STATEMENTS AND GUIDELINES Kleindorfer developing thrombus), one might consider empiri- cal anticoagulation even in the absence of demon- strated thrombus. Knowledge Gaps and Future Research Ventricular thrombus complicating insults to LV function can present a challenge to the care team. Our under- standing is based on aging data and small case series, leaving gaps in our knowledge and opportunities for future research in diagnosis, prognosis, and therapy. Often, the initial manifestation of LV thrombus is stroke. Identifying patients at highest risk of devel- oping LV thrombus before it forms may prevent stroke. 