In this meta-analysis, warfarin decreased the risk of stroke (OR, 0.75; 95% CI, 0.63 0.89) but increased the risk of bleeding. The 2013 ACCF/AHA guideline for the management of ST-segment elevation MI (STEMI) states that anticoagulant therapy with a vitamin K antagonist is reason- able for patients with STEMI and asymptomatic left ventricu- lar mural thrombi (Class IIa; Level of Evidence C) and that anticoagulant therapy may be considered for patients with STEMI and anterior apical akinesis or dyskinesis (Class IIb; Level of Evidence C).453 Cardiomyopathy The incidence of stroke in patients with cardiomyopathy and The Warfarin/ Aspirin Study in Heart Failure (WASH) randomized patients with heart failure, reduced left ventricular systolic function, and no other indications for anticoagulant therapy to warfarin, aspirin, or no treatment.454 There was no difference between groups in the primary composite cardiovascular end point, which included stroke. The Warfarin and Antiplatelet Therapy in Chronic Heart Failure (WATCH) trial randomized patients with heart failure, reduced left ventricular systolic function, and sinus rhythm to warfarin, clopidogrel, or aspirin. The study was terminated early because of slow enrollment. 