Both administration of microbubble contrast with transthoracic echocardiography and cardiac MRI have been shown to be superior to echocardiog- raphy without contrast for the detection of LV thrombus. Both modalities also increase the defi- nition of MI size where larger areas of infarction increase the risk of thrombus formation. In a study of 210 patients with cardiac MRI and echocar- diography after ST-segment elevation MI, cardiac MRI detected LV thrombus in 12.3% of patients, and echocardiography detected LV thrombus Another single-center study of 201 patients with ST-segment elevation MI also noted lower rates of LV thrombus detection using echo- cardiography (35%) and contrast echocardiogra- phy (64%) compared with cardiac MRI.511 Overall, detection of LV thrombus is increased by admin- istration of microbubble contrast, and cardiac MRI has the highest demonstrated sensitivity.512 Tailoring imaging strategy on the basis of patient risk may optimize diagnostic yield. 3. In a pooled meta-analysis of studies of mural throm- bus after anterior MI, use of oral anticoagulation with VKA reduced the risk of stroke by 86% and resulted in resolution of LV thrombus in 68%.506 Anticoagulation with DOACs has been shown to be as effective as VKA for the prevention of stroke in AF and for the treatment of deep vein thrombosis and pulmonary embolism with a lower risk of bleed- ing and with greater convenience, driving interest in use for LV thrombus. 