Direct Oral Anticoagulants for Cancer-Associated Venous Thromboembolism in Hematologic Malignancies: A Comprehensive Review.

Venous thromboembolism presents a critical complication in hematologic malignancies, profoundly affecting patient outcomes. Traditional anticoagulant options, low-molecular-weight heparin and vitamin K antagonists, encounter significant limitations, especially concerning bleeding risks exacerbated by chemotherapy-induced thrombocytopenia. Direct oral anticoagulants (DOACs), including factor Xa inhibitors (apixaban, rivaroxaban, edoxaban) and thrombin inhibitors (dabigatran), have emerged as appealing alternatives due to their ease of use, predictable pharmacokinetics, and reduced monitoring requirements. However, their safety and optimal use remain uncertain in hematologic malignancies due to underrepresentation in clinical trials and specific bleeding risks. This review comprehensively summarizes current evidence regarding DOAC safety, efficacy, and clinical management considerations in leukemia, lymphoma, multiple myeloma, and myeloproliferative neoplasms. It emphasizes individualized anticoagulation strategies, highlights existing evidence gaps, and outlines future research priorities, particularly the safe application of DOACs in severe thrombocytopenia and interactions with targeted therapies. Ultimately, tailored anticoagulant approaches are essential to optimizing patient outcomes in this complex patient population.