When do you start anticoagulation for secondary prevention in patients with HFrEF and history of embolic strokes?

Current guidelines consider anticoagulation in patients with reduced EF as class III (no benefit and possibility of harm), which has not changed significantly since WARCEF was published. The most recent randomized large trial, COMMANDER HF, looked at primary stroke prevention (among other thrombotic events) using 2.5 mg rivaroxaban BID in patients with a recent worsening of heart failure. Over 5000 patients were included, with a median EF of 35%. In this study, there was no benefit for rivaroxab...