Anticoagulant therapy with a vitamin K antagonist should be provided to patients with STEMI and AF with CHADS2 score# greater than or equal to 2, me- chanical heart valves, venous thromboembolism, or hypercoagulable disorder. (Level of Evidence: C) 2. The duration of triple antithrombotic therapy with a vitamin K antagonist, aspirin, and a P2Y12 receptor inhibitor should be minimized to the extent possible to limit the risk of bleeding.** (Level of Evidence: C) Class IIa 1. Anticoagulant therapy with a vitamin K antagonist is reasonable for patients with STEMI and asymptom- atic LV mural thrombi. (Level of Evidence: C) Class IIb 1. Anticoagulant therapy may be considered for pa- tients with STEMI and anterior apical akinesis or dyskinesis. (Level of Evidence: C) 2. Targeting vitamin K antagonist therapy to a lower international normalized ratio (eg, 2.0 to 2.5) might be considered in patients with STEMI who are re- ceiving DAPT. (Level of Evidence: C) Previous recommendations for the use of vitamin K antagonists, either alone or in combination with low-dose aspirin, for second- ary prevention or for reducing the risk of systemic thromboem- bolism after STEMI, must be reconsidered in the era of DAPT.4,48 The availability of several P2Y12 receptor inhibitors has virtually eliminated the former reliance on vitamin K antagonists as an alternative to aspirin for aspirin-allergic patients. A meta-analy- sis of RCTs comparing warfarin plus aspirin to aspirin alone in patients with ACS showed that in studies with an international normalized ratio goal of 2.0 to 3.0, combination therapy was associated with a significant reduction in major adverse events at the expense of an increased risk of major bleeding.521 None of the trials included patients treated with primary PCI or DAPT. 