Background The formation of blood clots in the veins, known as venous thromboembolism (VTE), which includes conditions like deep vein thrombosis (DVT) and pulmonary embolism (PE), is a notable risk following a heart attack (myocardial infarction, MI).Effective anticoagulation therapy is crucial in preventing recurrent thrombotic events and reducing mortality. While warfarin has traditionally been used for VTE management, ‘direct oral anticoagulants (DOACs) have emerged as an alternative with potential advantages in terms of safety, efficacy, and ease of use’. This study compares the outcomes of DOACs and warfarin in the emergency management of VTE after MI. Methods This prospective and retrospective observational study was conducted at Jinnah Medical College Peshawar from January 2023 to January 2024, including 93 patients diagnosed with VTE following MI. ‘Patients were treated with either DOACs (apixaban, rivaroxaban, dabigatran, or edoxaban) or warfarin’. Clinical data, including patient demographics, comorbidities, and treatment details, were collected. The primary outcomes assessed were recurrent VTE within 90 days and time to achieve therapeutic anticoagulation. Secondary outcomes included major bleeding events, intracranial hemorrhage, hospital readmission rates, and all-cause mortality at 90 days. Results Patients receiving DOACs had a significantly lower incidence of recurrent VTE (4.5% vs. 7.8%, p=0.04) and achieved therapeutic anticoagulation faster (1.5 ± 0.7 days vs. 4.2 ± 1.1 days, p<0.01) compared to warfarin users. DOACs were associated with a lower risk of major bleeding events (3.2% vs. 6.5%, p=0.03) and intracranial hemorrhage (0.8% vs. 2.3%, p=0.05). ‘Hospital readmission rates were lower in the DOAC group (5.1% vs. 8.9%, p=0.02), and all-cause mortality at 90 days was significantly reduced (2.7% vs. 4.6%, p=0.04) compared to warfarin’. Conclusion The findings of this study suggest that DOACs are a safer and more effective alternative to warfarin in the emergency management of VTE following MI. They provide faster anticoagulation, lower recurrence rates, fewer bleeding complications, and improved patient outcomes, making them a preferable choice in most clinical scenarios. Future studies with long-term follow-up are needed to further evaluate their benefits in high-risk populations.