Recommendation 40: We recommend acetylsalicylic acid (ASA) at a dose of between 75 to 162 mg be considered only in patients with HFrEF with clear indications for secondary prevention of atherosclerotic cardiovascular events (Strong Recommendation, High Quality Evidence).

Recommendation 41: We recommend against routine anticoagulation use in patients with HFrEF who are in sinus rhythm and have no other indication for anticoagulation (Strong Recommendation, High Quality Evidence).

Recommendation 42: We recommend against routine anticoagulation after large anterior MI and low EF, in the absence of intracardiac thrombus or other indications for anticoagulation (Weak Recommendation, Low Quality Evidence).

Values and preferences: High value is placed on the paucity of compelling evidence supporting efficacy and the potential for harm of bleeding given the contemporary treatment recommendations with dual antiplatelet therapy (DAPT) post MI, the emerging efficacy of direct oral anticoagulants post PCI and the lack of high quality trial evidence for anticoagulation with warfarin post-MI.

• Anticoagulation may be considered in those with a LV thrombus.
• If anticoagulation is used, a duration of three months before re-evaluating is reasonable.
• Either warfarin or direct oral anticoagulant could be used for LV thrombus based on the lack of trial evidence and mechanism of action.