Lung cancer is strongly associated with a hypercoagulable state, significantly increasing the risk of venous thromboembolism (VTE) and complicating clinical management. The mechanisms underlying cancer-associated coagulopathy are multifactorial, involving tumor-derived procoagulants, chronic inflammation, endothelial dysfunction, autoim-mune phenomena, and treatment-induced effects. These processes not only drive throm-bosis but also influence disease progression and therapeutic decisions. Moreover, the presence of antiphospholipid antibodies and acquired inhibitors of coagulation adds fur-ther complexity by simultaneously predisposing patients to both thrombosis and bleed-ing. This review provides a clinically oriented synthesis of the current evidence on coagu-lation abnormalities in lung cancer, highlighting diagnostic strategies—including mixing studies and biomarker evaluation—and exploring treatment approaches such as low-molecular-weight heparins, direct oral anticoagulants, and immunosuppressive regimens. Recognizing and managing coagulation disorders is essential for optimizing outcomes in lung cancer patients, and a multidisciplinary, personalized approach is in-creasingly warranted in oncologic practice.