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Abstract Background Patients with myeloproliferative neoplasms (MPNs), such as polycythemia vera (PV), essential thrombocythemia (ET), and primary myelofibrosis (PMF), are at an increased risk of recurrent thromboembolic events (TEs) and hemorrhagic complications. Anticoagulation with vitamin K antagonists (VKAs) had been the standard of care until the recent US Food and Drug Administration approval of direct oral anticoagulants (DOACs) for treatment of cancer‐associated thrombosis. However, since patients with MPNs were underrepresented in large studies, the use of DOACs in patients with MPN‐associated thrombosis remains understudied. Objectives The primary objective of this study was to establish the incidence of recurrent TEs and hemorrhagic complications in patients with MPN‐associated thrombosis treated with DOACs versus VKAs as first‐line therapy. Methods Data from 30 patients ≥18 years old with established diagnoses of PV or ET who were treated with either DOACs or VKAs as the first‐line anticoagulant for arterial and/or venous thrombosis were reviewed to determine the incidence of recurrent TEs as well as hemorrhagic complications. Results Nineteen patients were treated with DOACs, and 11 were treated with VKAs. Of those on DOACs, 1 had a recurrent thrombosis, and 4 had bleeding events. Of the 11 patients treated with VKAs, 1 had a recurrent thrombotic event, and 1 had a bleeding event. Conclusion Our data did not demonstrate a significant difference in recurrent TEs or bleeding events in patients with MPN‐associated thrombosis anticoagulated with either DOACs or VKAs.