Left Ventricular mural thrombus detected by echocardiography in 41 patients after myocardial infarction (MI) were followed up for 4 years. Thirty eight patients were males and mean age of study population was 52.4 years. Echocardiography revealed predominant mural type of thrombi (38 patients) and none showed mobility. All of them showed regional wall motion abnormality (RWMA) and Left Ventricular (LV) aneurysm was found in 28 patients. Embolic events were observed in 6 patients and 1 patient died following embolic stroke. Follow up study revealed persistent left ventricular thrombus in 19 patients and risk factors detected were severe LV dysfunction and LV aneurysm. Six patients had spontaneous resolution and 6 had resolution of the thrombus after anticoagulants. While anticoagulant therapy was very effective in preventing embolism after recent MI (within 3 weeks), it was found not useful in chronic LV thrombi. We observed ongoing embolic risk in chronic LV thrombi with LV aneurysms but a randomised trial is needed to decide the role of anticoagulants in such situation.