When and should you consider Watchmans for patients with high bleed risk/recurrent GI bleeds and valvular atrial fibrillation with moderate-severe mitral stenosis?

I am not aware of any studies that include those patients.

In terms of watchmen in general, the debate still rages on. The most recent trial (non-industry funded) is the CLOSURE-AF Trial, which found that standard medical therapy (anticoagulation) was superior to catheter-based left atrial appendage closure (LAAC) for preventing stroke, embolism, death, or major bleeding in high risk group.

Thus, I would lean away from that, but that is opinion and not evidence-based.