Balancing the safety and efficacy of antithrombotic agents in patients with gastrointestinal disorders is challenging because of the potential for interference with the absorption of antithrombotic drugs and for an increased risk of bleeding. In this Review, we address considerations for enteral antithrombotic therapy in patients with cardiovascular disease and gastrointestinal comorbidities. For those with gastrointestinal bleeding (GIB), we summarize a general scheme for risk stratification and clinical evidence on risk reduction approaches, such as limiting the use of concomitant medications that increase the risk of GIB and the potential utility of gastrointestinal protection strategies (such as proton pump inhibitors or histamine type 2 receptor antagonists). Furthermore, we summarize the best available evidence and potential gaps in our knowledge on tailoring antithrombotic therapy in patients with active or recent GIB and in those at high risk of GIB but without active or recent GIB. Finally, we review the recommendations provided by major medical societies, highlighting the crucial role of teamwork and multidisciplinary discussions to customize the antithrombotic regimen in patients with coexisting cardiovascular and gastrointestinal diseases.

在胃肠道疾病患者中平衡抗血栓药物的安全性和有效性具有挑战性，因为可能会干扰抗血栓药物的吸收并增加出血风险。在这篇综述中，我们讨论了患有心血管疾病和胃肠道合并症的患者进行肠内抗血栓治疗的注意事项。对于胃肠道出血 (GIB) 患者，我们总结了风险分层的一般方案和降低风险方法的临床证据，例如限制使用增加 GIB 风险的合并药物以及胃肠道保护策略的潜在效用（例如质子泵抑制剂或组胺 2 型受体拮抗剂）。此外，我们总结了针对活动性或近期 GIB 患者以及 GIB 高风险但无活动性或近期 GIB 患者制定抗血栓治疗的最佳可用证据和我们知识中的潜在差距。最后，我们回顾了主要医学会提供的建议，强调团队合作和多学科讨论对于合并心血管和胃肠道疾病患者定制抗血栓治疗方案的关键作用。