Therefore, the effectiveness of anticoagulation versus antiplatelet therapy is uncertain, and the choice should be indi- vidualized by taking into account bleeding risk and estimated risk of recurrent thromboembolism. 5. The only randomized trial evaluating the benefit of DOACs (dabigatran) in stable patients after LVAD implantation was stopped prematurely because of an excess of thromboembolic events.529 At the time of writing, there is no randomized study evaluat- ing the safety and efficacy of other DOACs in the LVAD population, and warfarin remains the only recommended oral anticoagulant in these patients. Knowledge Gaps and Future Research RCTs of stroke prevention in patients with non- valvular AF have demonstrated that DOACs are noninferior to warfarin in preventing ischemic stroke with a lower risk of bleeding. Advantages of DOAC therapy compared with warfarin include a more predictable pharmacokinetic profile requiring no monitoring, fewer interactions with other drugs, and a rapid onset/offset of action. The extent to which data from randomized trials in nonvalvular AF can be generalized to other clinical scenarios such as prevention of thrombo- embolism from intracardiac thrombus in patients with congestive heart failure or prevention of recurrent stroke/TIA in patients with specific types of cardiomyopathy (eg, LV noncompaction) requires further investigation. Data from isolated case reports and small case series suggest that DOACs or low-molecular-weight hepa- rin may be beneficial in these clinical scenarios, but larger-scale multicenter observational data will be necessary to clarify whether DOACs or low-molecu- lar-weight heparin can be used safely and effectively in these patients.551 The role of empirical oral anticoagulation in patients with cardiomyopathy, reduced EF, and a history of stroke/TIA should also be investigated further in future studies because these patients were largely underrepresented in RCTs of prophylactic oral anti- coagulation in patients with cardiomyopathies and reduced EF. 5.4.5. 