ICU Stress Ulcer Bleeding

A 67-year-old man on day 6 of mechanical ventilation for severe pneumonia and septic shock develops hemodynamic instability (MAP 58 mmHg on noradrenaline 0.4 µg/kg/min), a drop in hemoglobin from 11.2 to 7.8 g/dL, and black nasogastric aspirate. Laboratory studies show INR 1.6 and platelets 78/μL. Stress ulcer prophylaxis had been discontinued on day 3. Urgent upper endoscopy reveals multiple shallow erosions and two larger ulcers with Forrest IIa (visible vessel) and Forrest Ib (oozing) lesions in the gastric body and fundus, consistent with stress-related mucosal disease. Which of the following management approaches marked as **A** in the diagram best addresses the acute bleeding and underlying pathophysiology in this critically ill patient?