Importantly, the risk of embolic stroke is increased in patients with anterior MI and left ventricular thrombus. Contemporary studies have found that left ventric- ular thrombus affects 6% to 15% of patients with anterior MI and 27% with anterior MI and left ventricular ejection Systemic embolism occurs in 11% of patients with left ventricular thrombus.450 In the Warfarin, Aspirin Reinfarction Study, (WARIS II), warfarin, combined with aspirin or given alone, compared with aspirin alone reduced the risk of thromboembolic stroke but was associated with a greater risk of bleeding.451 A meta-analysis of 14 trials comprising 25307 patients with an acute coronary syndrome reported that aspirin plus warfarin, in which the achieved INR was 2.0 to 3.0, compared with aspirin alone reduced the risk of death, nonfatal MI, and nonfatal thromboembolic stroke but doubled the risk of major bleeding.452 A meta-analysis of 24542 patients in 10 randomized trials that evaluated the effi- cacy of warfarin after acute MI found a stroke incidence over 5 years of 2.4%. 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. 