<p>Venous thromboembolism (VTE) remains a critical complication in oncology, significantly contributing to morbidity and mortality among cancer patients. The hypercoagulable state associated with malignancy is often aggravated by surgical procedures and systemic anticancer therapies, which further elevate the risk of thrombotic events. Effective management of cancer-associated thrombosis (CAT) is essential and relies on evidence-based prophylactic strategies. Low molecular weight heparins (LMWH) remain the cornerstone of anticoagulation for high-risk patients due to their well-established efficacy and safety profiles. The emergence of direct oral anticoagulants (DOACs), such as apixaban and rivaroxaban, offers new opportunities in CAT management. These agents have shown promising efficacy and convenience in clinical trials. However, their widespread application is constrained by concerns regarding bleeding risks and potential interactions with cancer therapies. To address these challenges, risk stratification tools such as the Khorana score and the more recent COMPASS-CAT score have been developed, enabling clinicians to identify patients at high risk and implement tailored thromboprophylaxis.Hence these scores are appropriate for ambulatory patients. Furthermore, novel anticoagulants targeting factor XI are being investigated and may represent a breakthrough in improving the safety and efficacy of anticoagulation in cancer patients. These advancements emphasize the growing importance of a personalized and multidisciplinary approach in managing CAT, integrating innovative therapies and precision risk assessment to optimize patient outcomes. This review highlights recent progress in the field of cancer-associated thrombosis, focusing on advancements in risk assessment models, evolving anticoagulation strategies, and the development of emerging therapies aimed at reducing complications while improving clinical efficacy.</p>