To investigate gas flow characteristics in coal seams with strong anisotropy, a coupled anisotropic dual-porosity model was established. Effects of permeability anisotropy on variations in gas pressure, gas extraction volume and effective extraction areas were analyzed. Furthermore, mechanisms of crustal stress, initial gas pressure, ultimate adsorption strain and Langmuir volume constant on permeability anisotropy and extraction amount were studied. Results show that permeability anisotropy could result in an elliptical pressure drop zone around production boreholes. Changes in effective gas extraction areas are divided into three stages: slow growth in an elliptical shape, rapid growth with a superposition effect and steady growth in a funnel shape. Permeability isotropy enables faster reaching of stage III than the anisotropy case. As the vertical stress increases, gas pressure distribution around boreholes gradually changes from an ellipse with horizontal direction as long axis to a circle. Larger initial gas pressure could bring consistently higher gas production in the initial and middle extraction stages, and a faster decrease in the late phase. When gas pressure is 2.5 MPa, the peak daily gas production in initial extraction stage is about three times higher than that in the late phase. Ultimate adsorption strain is positively correlated with permeability change. This relationship becomes more significant with a longer extraction time. In contrast, permeability variation is inversely proportional to the Langmuir volume constant in the initial extraction stage. However, these factors are directly proportional in the late stage. The order of significance of each factor’s effect on permeability is crustal stress > ultimate adsorption strain > initial gas pressure > Langmuir volume constant. Moreover, initial gas pressure has the most significant effect on gas extraction volume, while Langmuir volume constant has the least significant impact. Results could provide a theoretical reference for extraction borehole design and drainage parameter setting to improve extraction performance.