What is your preferred choice of anticoagulant (VKA vs. DOAC) in patients with an LV thrombus and apical infarct? 

Traditionally, warfarin is recommended. However, there has been recent evidence to suggest that DOACS are effective as well. In my practice, I have migrated to DOACS for ease of use. Many elderly patients are overwhelmed when they are discharged with 6 or 7 medications and add to that the complexity...

I have been using DOACs for years to treat LV thrombus. While there are no large RCTs comparing DOAC vs warfarin, there are numerous case-controlled, retrospective, etc trials comparing the 2 with similar efficacy. Not sure that you need an RCT to use a DOAC. Was there ever an RCT for warfarin for t...

In such patients, I would opt for a VKA as we have more experience with these agents than a DOAC in this setting. I would not extend the anticoagulation time if the thrombus resolved over time as shown by CMR, since it is not apical akinesis alone that is typically associated with a thrombus it is a...