The effectiveness of oral anticoagulation compared with antiplatelet therapy in patients with cardiomyopathy and reduced EF and ischemic stroke or TIA in sinus rhythm with no evidence of left atrial or LV thrombus is uncertain, and the choice should be individualized, taking into account the bleed- ing risk and estimated risk of recurrent thromboembo- Patients with LVADs have a high prevalence of neurological complications (thromboembolic/hemor- rhagic). Warfarin together with aspirin is the standard antithrombotic regimen to minimize the risk of LVAD and to prevent recurrent ischemic stroke or TIA. At this point, the use of DOACs in patients with LVAD should be avoided.529 Recommendation-Specific Supportive Text 1. The prevalence of intracardiac thrombosis in patients with cardiomyopathy has not been con- clusively determined, and it varies between differ- ent underlying causes. In a retrospective database including 86374 patients, 62 cases (0.7%) of LV thrombosis were identified. The majority of patients (81%) had ischemic cardiomyopathy, and the remaining had a nonischemic type.537 Oral antico- agulation with warfarin has been used in patients with intracardiac thrombus, and the efficacy has been documented in several observational stud- A duration of therapy <3 months has been associated with a higher recurrence rate.539 The evidence for the use of DOACs in patients with intracardiac thrombus is limited largely to isolated case reports and small case series.529,540 546 It is also important to note that DOACs have not been studied specifically to prevent thromboembolism in patients with documented LV or left atrial throm- bus. In addition, uncertainty about the optimal dos- ing of DOACs and the long-term safety remains. 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. 