Aim To compare the clinical efficacy of dabigatran and warfarin in acute myocardial infarction with left ventricular thrombosis (LVT). Methods A total of 116 patients diagnosed with acute myocardial infarction and LVT who were hospitalized in Liaoning Provincial People's Hospital from september 2015 to march 2020 were collected and randomly divided into warfarin group and dabigatran group. Stroke rate, bleeding event rate, coagulation function indexes before and after 3 months of treatment, liver function indexes before and 1 month and 3 months after treatment were observed, and the disappearance time of thrombosis, new thromboembolic events and bleeding events during treatment were compared between the two groups. Results During the treatment, the dabigatran group had fewer total embolization events than the warfarin group (3.4% vs 24.1%, P＝0.002), of which cerebral embolism (1.7% vs 15.5%, P＝0.016) was statistically significant (P＜0.05); There was no statistically significant difference in prothrombin time(PT), thrombin time(TT) and fibrinogen(FIB) between the two groups (P＞0.05), activated partial thromboplastin time(APTT) was higher in the dabigatran group than that in warfarin group (P＜0.05). There was no statistically significant difference in liver function indexes of patients 1 month and 3 months after treatment between the two groups (P＞0.05). Compared with the warfarin group, the patients in the dabigatran group had a shorter thrombus disappearance time ((47.00±5.30) days vs (69.10±7.90) days, P＜0.01). The number of cases of left ventricular thrombus disappearance in dabigata group was significantly more than that in warfarin group(77.6% vs 39.7%, P=0.032). The incidence of bleeding in dabigatran group was lower than that of warfarin group (3.4% vs 17.2%, P＜0.05). Conclusion Dabigatran is safer and more effective than warfarin in the treatment of patients with acute myocardial infarction and left ventricular thrombosis.