The Role of Direct Oral Anticoagulants (DOACs) in Cancer-Associated Thrombosis: A Comprehensive Review of the Literature

Venous thromboembolism (VTE) is a frequent and serious complication observed in patients with malignancy. The management of cancer-associated thrombosis (CAT) remains complex and multifactorial, influenced by cancer type, stage, comorbidities, and ongoing therapeutic regimens. Among anticoagulation strategies, direct oral anticoagulants (DOACs) have gained increasing attention as potential alternatives to low-molecular-weight heparins (LMWHs) in selected oncology populations. This narrative review evaluates the role of DOACs in the treatment of CAT, focusing on their clinical efficacy, safety considerations, and practical advantages, including oral administration and patient adherence. However, their use may be limited in certain cancer types and patients with renal or hepatic impairment. DOACs have also raised concerns regarding bleeding risks, drug interactions, and individualized dosing strategies. This review also highlights ongoing challenges such as optimal treatment duration, real-world applicability, and patient-specific considerations. The discussion aims to assess current data and clinical guidance while identifying future directions for integrating DOACs into standard oncology practice.