Background: Treatment of venous thromboembolism (VTE) in cancer patients is a challenge due to the high risk of recurrence and bleeding. Low molecular weight heparin has been the standard of care for these patients. Recently two randomized controlled trials accessed the efficacy and safety of direct oral anticoagulants (DOACs) for treatment of VTE in cancer patients. The aim of this meta-analysis is to pool all the data from randomized controlled trials to access the efficacy and safety of DOACs in cancer patients. Methods: A systematic literature search was performed to identify randomized controlled trials studying the role of DOACs versus LMWH or warfarin for the treatment of VTE. We identified the subgroup of cancer patients with VTE treated with DOACs in these trials. We did a meta-analysis of all cancer patients with VTE with CMA-III. Primary endpoint was recurrent VTE and secondary endpoints were any major episode of bleeding and or clinically relevant non major bleeding episode (CRNMB) and all-cause mortality. A subgroup analysis of DOACs versus LMWH was done for both the primary and secondary endpoints. Results: We identified eight RCTs with 2568 cancer patients. 1275 patients were treated with DOACs and 1293 patients were treated with either vitamin K antagonists (VKA) or low molecular weight heparin (LMWH). VTE recurrence rate was significantly lower in the DOACs group 4.7% versus VKA/LMWH group 7.1 % with HR: 0.67, 95% CI: 0.49-0.91, P: 0.01. There was no statistically significant difference in the risk of major bleeding/CRNMBs rate 18.9% in the DOACs group versus 13.45% in the VTE/LMWH group (HR: 1.26, 95% CI: 0.89-1.79, P:0.20). There was no statically difference in all-cause mortality between the two groups (HR 1.02, 95% CI 0.90-1.16, P: 0.77). Subgroup analysis of DOACs vs LMWH failed to show any significant difference between two groups. Conclusions: DOACs are associated with decreased risk of VTE recurrence with out significant increased risk of bleeding in cancer patients with VTE. As there was no difference in mortality and degree of bleeding is similar, patients with cancer can be treated with DOACs as an alternative to VKA/LMWH.