Anticoagulation in Post MI LV Thrombus Trial in Nepal

Inclusion Criteria: * Patients aged \>18 years hospitalized with the diagnosis of acute STEMI and * Presence of LV thrombus which is confirmed with cardiac MRI. Exclusion Criteria: 1. Bleeding risk Active bleeding; history of intracranial hemorrhage; clinically significant gastrointestinal bleeding within 12 months before randomization; severe thrombocytopenia (\<50×109/L), or anemia (i.e., hemoglobin \<90 g/L) at screening or pre-randomization; Liver function Child-Pugh B or C; untreated arterial aneurysm, arterial or venous malformation and aorta dissection; and body weight \<40 kg. 2. Undergoing anticoagulation therapy 3. Cardiovascular condition Cardiac shock; uncontrolled blood pressure (SBP ≥180 mmHg); planned CABG within 3 months; suspicious Pseudo-ventricular aneurysm 4. Concomitant diseases Severe chronic or acute renal failure (CrCl \<50 mL/min at screening or pre-randomization); significant liver disease; current substance abuse (drug or alcohol) problem; life expectancy to less than 12 months; Known allergies, or intolerance to rivaroxaban; Woman who is currently pregnant, or breastfeeding; and Other hypercoagulable states, such as a malignant tumor, SLE 5. Other conditions adjudicated by investigators to be unsuitable for anticoagulation 6. Pregnant women and participants with any cognitive impairment.