Abstract: Venous thromboembolism (VTE), a clinically significant venous circulatory disorder comprising interrelated conditions, including pulmonary embolism (PE) and deep vein thrombosis (DVT), is a life-threatening complication in patients with cancer. Patients with advanced gastric carcinoma displayed a particularly high susceptibility to VTE, exhibiting substantially higher incidence rates than thosewith other malignancies. Although anticoagulation therapy is the mainstay of VTE management by reducing thrombotic mortality, it presents unique challenges in this population, including tumor-associated hemorrhage, pharmacokinetic interactions, and limited life expectancy. This comprehensive review has evaluated VTE-associated risk factors, delineated the risk-benefit profile of anticoagulant interventions, and proposed individualized therapeutic algorithms for patients with advanced gastric cancer, thus providing clinicians with evidence-based strategies to optimize the critical balance between thromboprophylaxis and bleeding risk mitigation.