Left ventricular (LV) systolic dysfunction and chronic systolic heart failure (HF) predispose to intraventricular thrombus formation and embolization resulting in stroke. Current guideline recommends the use of oral anticoagulants in patients with atrial fibrillation and history of previous thromboembolism. However, anticoagulant treatment in patients with LV systolic dysfunction with sinus rhythm and without history of previous thromboembolism is still on debate. Recent epidemiologic date has reported increased stroke rate in patients with systolic HF shortly after diagnosis. This review focuses on the possible causes of increased stroke rate shortly after the diagnosis of HF and subsequently suggests a rationale for the use of oral anticoagulant in these patient groups.