Sepsis can trigger the onset of atrial fibrillation (AF). When AF occurs in septic patients, hospital length of stay is often prolonged, and the risk of in-hospital mortality increases. Compared to septic patients without AF, those with sepsis-induced AF face nearly a threefold increase in the risk of in-hospital stroke. Clinically, there is an ongoing debate over whether anticoagulant therapy should be administered to septic patients with concurrent AF. Some advocate for anticoagulation to reduce the incidence of ischemic stroke, while other caution that it may increase the risk of bleeding. In light of these differing perspectives, this article reviews both domestic and international literature to explore whether anticoagulant therapy should be initiated in septic patients with AF, particularly in cases of new-onset AF. The goal is to enhance clinicians' understanding of anticoagulation strategies in this context and to provide guidance on better balancing the potential benefits of anticoagulation with the associated risks of bleeding.