Heart failure (HF) with reduced left ventricular function inflicts a large and growing burden of morbidity and mortality in the US and across the globe.  One source of this burden is stroke.  While it appears that HF itself may impose some risk of stroke, it is in the presence of other risk factors, like atrial fibrillation, that the greatest risks are observed.  Therapeutic anticoagulation is the mainstay of risk reduction strategies in this population.  While warfarin was the only available therapy for anticoagulation for many decades, there are now four direct oral anticoagulants available.  In three of these four, outcomes in the specific subgroup of patients with heart failure have been examined.  In this review, we provide some pathophysiologic basis for the risk of stroke in heart failure.  In addition, the available therapeutic options for stroke risk prevention in heart failure are described in detail including how these options are incorporated into relevant professional society guidelines.