Patients with dilated cardiomyopathy have multiple factors that predispose to thromboembolic events. However, reports of the incidence of thromboembolic events in this population vary widely. There has never been a controlled study of long-term anticoagulation among patients with congestive heart failure due to dilated cardiomyopathy. In this report we review the available published data regarding the risk of thromboembolic events in patients with dilated cardiomyopathy, and the effectiveness and risks of anticoagulation in this population. Although many investigators have called for a prospective, randomized clinical trial to assess the risks and benefits of long-term anticoagulation in patients with dilated cardiomyopathy, a more practical approach may be to compile a national registry of patients with dilated cardiomyopathy to collect observational data on both the rate of embolic events as well as bleeding complications among patients with and without anticoagulation.