LV Thrombus Pilot Study for Comparing Enoxaparin Vs. Warfarin

Inclusion Criteria: Age 18 to 80 Anterior myocardial infarction with: Pathological Q-waves in at least 3 contiguous anterior precordial leads, assumed to be new CK peak>5 times the upper limit of normal with positive MB bands Ejection fraction <=40% or anterior dyskinesis or documented LV Thrombus MI onset < 7 days from randomization Exclusion Criteria: Inability to give written informed consent Medical conditions that would prohibit discharge within 48 hours with the exception of need for anticoagulation Cardiogenic shock, rest angina unresponsive to medical therapy or serious ventricular arrhythmia in the 24 hours prior to randomization Patients scheduled for surgical procedure in the next 4 months that would prevent use of enoxaparin or warfarin Anemia: Baseline Hgb<=9 gm for women, <=10 gm for men or platelet count<100,000 Renal insufficiency (creatinine >2.0 mg/dl) Serious liver disease as reflected by INR>1.3 Stroke within past 6 months or a prior documented intracranial or subarachnoid hemorrhage Active bleeding or major surgery within 2 weeks prohibiting the use of anticoagulants Acute pericarditis Women of childbearing potential unless pregnancy test negative Cardiac or non-cardiac condition with expected survival< 6 months Severe peripheral vascular disease Patients who undergo cardiac surgery, including CABG, as a result of their index myocardial infarction Allergy to aspirin, heparin or warfarin, pork or pork products History of recurrent thromboembolic disease or a history of Protein C, Protein S, antithrombin III deficiency or known bleeding disorder. Current use of warfarin or need for chronic anticoagulation Current participation in other trials using investigational drugs or devices Prior enrollment in this trial