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...

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...