Direct oral anticoagulants (DOACs) are recommended for the prevention of thromboembolism in patients with atrial fibrillation (AF), and are now preferred over vitamin K antagonists due to their beneficial efficacy and safety profile. However, all oral anticoagulants carry a risk of gastrointestinal (GI) bleeding. Although the risk is well documented and acute bleeding well codified, there is limited high-quality evidence and no guidelines to guide physicians on the optimal management of anticoagulation after a GI bleeding event. The aim of this review is to provide a multidisciplinary critical discussion of the optimal management of GI bleeding in patients with AF receiving oral anticoagulants to help physicians provide individualized treatment for each patient and optimize outcomes. It is important to perform endoscopy when a patient presents with bleeding manifestations or hemodynamic instability to determine the bleed location and severity of bleeding and then perform initial resuscitation. Administration of all anticoagulants and antiplatelets should be stopped and bleeding allowed to resolve with time; however, anticoagulant reversal should be considered for patients who have life-threatening bleeding or when the bleeding is not controlled by the initial resuscitation. Anticoagulation needs to be timely resumed considering that bleeding risk outweighs thrombotic risk when anticoagulation is resumed early after the bleeding event. To prevent further bleeding, physicians should prescribe anticoagulant therapy with the lowest risk of GI bleeding, avoid medications with GI toxicity, and consider the effect of concomitant medications on potentiating the bleeding risk.

直接口服抗凝剂 (DOAC) 被推荐用于预防房颤 (AF) 患者的血栓栓塞，由于其有益的功效和安全性，目前比维生素 K 拮抗剂更受青睐。然而，所有口服抗凝剂都有胃肠道（GI）出血的风险。尽管风险已得到充分记录，并且急性出血也得到了详细记录，但高质量证据有限，并且没有指导医生在胃肠道出血事件后进行最佳抗凝治疗的指南。本综述的目的是对接受口服抗凝剂的房颤患者胃肠道出血的最佳治疗进行多学科批判性讨论，以帮助医生为每位患者提供个体化治疗并优化结果。当患者出现出血表现或血流动力学不稳定时，进行内窥镜检查以确定出血位置和出血严重程度并进行初步复苏非常重要。应停止使用所有抗凝剂和抗血小板药物，并让出血随时间消退；然而，对于出现危及生命的出血或初次复苏未能控制出血的患者，应考虑逆转抗凝治疗。考虑到出血事件后早期恢复抗凝，出血风险大于血栓形成风险，需要及时恢复抗凝。为了防止进一步出血，医生应开具胃肠道出血风险最低的抗凝治疗，避免使用具有胃肠道毒性的药物，