Back in 1865 the French physician Armand Trousseau noted the association between visceral malignancy and hypercoaguability. Cancer-associated VTE remains a serious clinical challenge today, and although oral vitamin K antagonists such as warfarin may not prove to be effective, previous useful approaches to management have included continuous SC infusion of unfractionated heparin and also intermittent low molecular weight heparin. Evidence is now emerging that Direct Oral Anticoagulants (DOACs) may prove useful also – in one study rivaroxaban appears to have outperformed LMWH, albeit at a cost of a higher rate of major bleeding among a subgroup of subjects with upper GI malignancies. Overall, there does appear to be promise, but further research is needed.