Anticoagulants and antiplatelet agents are widely used drugs for cardiovascular prevention and reducing the risk of thromboembolic events. Gastrointestinal bleeding represents a serious complication of their use. On the other hand gastrointestinal endoscopy is related with bleeding risk – there is bleeding risk stratification according to endoscopic procedures (high and low risk ones). Treatment with antithrombotic drugs in periprocedural endoscopic period is based on balancing the bleeding risk against the thromboembolic risk. Antithrombotic agents in endoscopic procedures with lower bleeding risk are not needed to be withheld. It’s recommended temporary discontinuation of antithrombotic treatment in high risk endoscopic procedures and to consider use of “bridging” therapy with LWMH for patients on vitamin K antagonist who are at high thrombotic risk. Evaluating cardiovascular risk and management of antithrombotic therapy could be a challenge for gastrointestinal endoscopist, therefore collaboration with cardiologist is of great importance, at least for some patients.