As the global population ages, the prevalence of thrombotic diseases and the use of antithrombotic drugs are rising. For patients undergoing digestive endoscopy, this presents a clinical dilemma: continuing medication increases bleeding risks, while discontinuing it raises the threat of thromboembolism. This article systematically reviews the latest domestic and international guidelines and consensus statements, focusing on stratifying bleeding risk for different digestive endoscopy procedures, assessing thromboembolism risk based on patients' comorbidities, and outlining perioperative management strategies for antithrombotic drugs. The aim is to provide a reference for the management of antithrombotic drugs during the perioperative period of digestive endoscopy in clinical practice.