What is your approach in deciding when to start (or briefly defer) anticoagulation in newly diagnosed Budd–Chiari syndrome with large esophageal varices and very recent banding?

Generally, we start IV heparin immediately, even if recent banding performed. Bleeding from varices is caused by transmural pressure, not anticoagulation. So interventions to address portal pressure should be prioritized, including anticoagulation and TIPS as soon as feasible.