How soon after an acute upper GI bleed do you restart therapeutic anticoagulation in a patient with atrial fibrillation and a high thromboembolic risk (CHA₂DS₂-VASc ≥4)?

In real-world inpatient practice:

• ~72 hours after endoscopic control for high-stroke-risk AF with stable hemoglobin and no rebleeding.
• Extending hold to 5–7 days if the lesion is high risk or the bleed was severe.

It really depends on the cause of the GI bleed. Many are due to malignancies, some require surgery, and situations that mandate longer interruptions or discontinuation.

Many of these patients have no source of gastritis and will add gastroprotective PPI and resume AC if no s/s of ongoing bleeding.