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Introduction While both direct oral anticoagulants (DOACs) and low molecular weight heparin (LMWH) have gained popularity over antiplatelet therapy for stroke prevention in non-cancer populations, their comparative safety in cancer-related stroke remains uncertain.Aim of Study This meta-analysis aims to evaluate the efficacy and safety of anticoagulation (DOACs and LMWH) versus antiplatelet therapy in patients with cancer-related stroke.Method PubMed, Embase, and Cochrane Central databases were systematically searched to identify studies comparing anticoagulation (DOACs or LMWH) with antiplatelet therapy in cancer-related stroke.. The primary outcome was the risk of recurrent stroke, while secondary outcomes included major bleeding and all-cause mortality. The meta-analyses were performed using a bivariate random-effects model to pool outcomes using risk ratios (RR) and 95% confidence intervals (CI). Statistical analyses were performed in R 4.4.1, with significance set at p < 0.05.Results Three studies with 700 patients (55% males, mean age: 70 years), with 325 patients in the anticoagulation group while 375 in the antiplatelet group were included in the analysis. The risk of recurrent stroke was similar between anticoagulation and antiplatelet groups (RR: 1.21; 95% CI: 0.69–2.11; p = 0.51), with no significant differences in major bleeding (RR: 1.82; 95% CI: 0.52–6.33; p = 0.35) or all-cause mortality (RR: 1.08; 95% CI: 0.50–2.33; p = 0.85).Conclusion Anticoagulation showed no significant difference from antiplatelet therapy in recurrent stroke, major bleeding, or all-cause mortality in cancer-related stroke, suggesting a comparable safety profile. However, larger trials are needed to confirm these findings and optimize anticoagulation strategies in this population.Conflict of Interest No