Left ventricular thrombus (LVT) is a common complication of heart diseases such as myocardial infarction and heart failure. Vitamin K antagonist (VKA) is currently the main method for LVT, but its use requires frequent monitoring of coagulation indicators, which may lead to poor patient compliance. The novel oral anticoagulant (NOAC) is easy to administer and does not require monitoring of international normalized ratio or dietary restrictions. With the development of NOAC, the position of VKA for LVT may gradually be replaced in the future. This article provides a review of the comparative efficacy of NOAC and VKA for LVT in recent years, in order to provide new ideas for the clinical use of NOAC for LVT.