Background: Cancer-associated venous thromboembolism (VTE) is a leading cause of morbidity and mortality in patients with various malignancies. Anticoagulation is crucial for preventing and treating thrombosis associated with cancer. However, its use faces challenges due to increased risks of bleeding, recurrent thrombosis and complexities in dosing, particularly in patients with concurrent comorbidities. Prophylactic anticoagulation is under-utilized and the cost of low- molecular-weight heparin (LMWH) and direct oral anticoagulants is a major barrier in developing countries. Methods: It was an ambispective observational study. All the cancer-associated thrombosis patients attending the thrombosis clinic at a tertiary-level referral hospital based in north India between 2018 and 2023 were analysed. Patient demographics, disease-related and treatment-related parameters were collected and analysed. The study was approved by the Institute Ethics Committee. Results: A total of 1312 patients attended the thrombosis clinic during study period, of which 139 (10.59%) cases were Cancer-associated VTE. The median age was 48 years and 61.2% were female. Most of VTE (54.6%) occurred within 6 months of cancer diagnosis and only 7% occurred after 3 years. Gynaecological malignancies (25.18%) and adenocarcinomas (21.58%) were the most common site and histological type of cancer respectively. Common risk factors observed for VTE development were: active cancer (80.3%), active chemotherapy (36.7%), cancer surgery (15.1%). Lower limb thrombosis was the most commonly seen type (46%), while abdominal and pulmonary thrombosis were seen in 17% and 7.9% respectively. Out of total patients, 124 (89.2%) patients received anticoagulation. Low molecular weight heparin (LMWH) was used as an initial anticoagulation in majority (52.41%) and direct oral anticoagulant (DOACs) was used as long term anticoagulation in 54% of patients. In 26 patients, anticoagulation was interrupted, the major reasons being bleeding and thrombocytopenia. There was no significant difference in frequency of bleeding with use of different anticoagulants (P = 0.48). Conclusions: Most cases of cancer associated VTE occur shortly after cancer diagnosis. Prophylactic anticoagulation is still underutilized in our patients with cancer. Early suspicion and prompt treatment can improve quality of life in such patients.