Direct oral anticoagulants (DOACs) have been approved for the treatment and secondary prevention of venous thromboembolism (VTE), and have achieved stable application among clinicians in recent years, with an expanding scope of use. Although routine monitoring is not required for fixed-dose DOACs, in the context of special patient populations presenting with factors such as extreme body weight, impaired hepatic or renal function, advanced age, pregnancy and lactation, and multiple comorbidities, DOACs introduce therapeutic uncertainties, potentially necessitating dose adjustment or exclusion from use. In such cases, consideration should be given to the use of traditional anticoagulants such as heparin or vitamin K antagonist (VKA). Increasing numbers of studies have been conducted to assess the safety and effectiveness of DOACs in these special VTE patient populations across a wide range of settings. This review consolidates and analyzes the latest research progress on DOACs in these special patient populations, providing evidence and insights for more rational use of DOACs in clinical practice and optimizing anticoagulation strategies.

直接口服抗凝药（DOACs）已被批准用于静脉血栓栓塞（VTE）的治疗和一、二级预防。近年来在临床中得到了稳定的应用并逐渐扩大适用范围。对于标准剂量DOACs虽然无需常规监测，但面对极端体质量、肝肾功能受损、高龄、妊娠与哺乳以及多种合并症的特殊患者群体，DOACs存在治疗的不确定性，可能需要调整剂量，或无法安全使用而给予肝素或维生素K拮抗剂（VKA）等传统抗凝药物。目前已有越来越多的学者针对这些特殊VTE患者群体开展研究，以评估DOACs在临床实践中的安全性和有效性。本综述整理分析了DOACs在特殊患者人群中的最新研究进展，为临床更加合理应用DOACs、优化抗凝策略提供证据和思路。