Abstract: The risk of venous thromboembolism (VTE) is significantly elevated in patients with multiple myeloma (MM), and the widespread use of immunomodulatory drugs has further increased this risk. For MM- related VTE, both domestic and international guidelines and consensus statements emphasize risk-stratified prophylaxis:aspirin may be selected for low-risk patients, whereas low-molecular-weight heparin, warfarin, or direct oral anticoagulants (DOACs) should be considered for intermediate- to high-risk patients. In recent years, DOACs have gradually emerged as a new option for MM-related VTE prophylaxis. The results of some small-sample single-arm studies, real-world cohort studies, and systematic reviews suggest that DOACs may have favorable safety and efficacy in patients with MM. This article reviews the risk factors for VTE in patients with MM, risk stratification strategies, and research advances in thromboprophylactic agents, with a focus on the prophylactic value of DOACs, aiming to provide a reference for clinical practice and subsequent research.