Identifying patients at highest risk of devel- oping LV thrombus before it forms may prevent stroke. Advanced imaging methods offer the prom- ise of identifying features of ventricular remodeling or dysfunction through strain patterns, blood vec- tor mapping, and hematologic assays that point to patients who are at highest risk and would benefit from prophylactic anticoagulation. Furthermore, the optimal timing and frequency of screening for LV thrombus remain poorly characterized and would benefit from longitudinal study. The optimal duration of anticoagulation in the set- ting of thrombus remains elusive. Natural history studies with serial advanced imaging could better determine LV thrombus embolic risk and the need for anticoagulation. Recommendations for Cardiomyopathy Referenced studies that support recommendations are summarized in online Data Supplements 36 and 37. COR LOE Recommendations In patients with ischemic stroke or TIA and left atrial or left atrial appendage thrombus in the setting of ischemic, nonischemic, or restrictive cardiomyopathy and LV dysfunction, antico- agulant therapy with warfarin is recommended for at least 3 months to reduce the risk of recurrent stroke or TIA. In patients with ischemic stroke or TIA in the setting of a mechanical assist device, treatment with warfarin and aspirin can be beneficial to reduce the risk of recurrent stroke or TIA.516 523 In patients with ischemic stroke or TIA in the setting of LV noncompaction, treatment with warfarin can be beneficial to reduce the risk of recurrent stroke or TIA. 