靜脈血栓栓塞是癌症病人常見的併發症，具有高復發及高出血風險，是除了癌症之外，容易造成病人死亡的主要併發症。根據2020年美國臨床腫瘤學會（American Society of Clinical Oncology, ASCO）更新的癌症病人靜脈血栓栓塞治療指引，除了使用低分子量肝素（Low Molecular Weight Heparin, LMWH）治療，直接口服抗凝血藥物（Direct Oral Anticoagulants, DOACs）也可用在癌症活動期或非活動期病人的靜脈血栓栓塞。抗凝血藥物的選擇與治療的時間，須考量病人活動力、腫瘤種類，整體評估其利益和風險來決定。近年來直接口服抗凝血藥物的大型臨床實驗對於癌症病人收錄大都少於10％，故在癌症病人的治療建議不明確。本文依據實證醫學手法篩選至2020年的臨床文獻，選擇最佳證據品質的文章進行評讀，提供癌症病人靜脈血栓藥物治療與預防的最佳選擇，並提供臨床人員與病人做醫病共享決策（Shared Decision Making, SDM），提高病人的用藥安全。

Venous thromboembolism (VTE) is a common complication in patients with cancer. It has a high risk of recurrence and bleeding, and can easily lead to patient death. According to the 2020 update of the American Society of Clinical Oncology (ASCO) guidelines on the treatment of VTE in patients with cancer, aside from treatment with a low molecular weight heparin (LMWH), direct oral anticoagulants (DOACs) can also be used to treat VTE in patients with active or inactive cancer. The choice of anticoagulants and the duration of treatment are determined by the patient’s conditions, the type of tumor, and an overall assessment of benefits and risks. Large-scale clinical trials of DOACs in recent years have recruited less than 10% of patients with cancer; thus, the treatment recommendations in these patients remain unclear. In this article, studies published till 2020 were filtered using evidence-based medicine to select papers with the highest quality of evidence and to provide the best choice of drugs in the treatment and prophylaxis of VTE in patients with cancer. This paper offers shared decision making (SDM) between clinicians and patients and improves medication safety in patients.