Do you avoid ESA use in patients with anemia and chronic kidney disease who also have APLS and risk for thrombosis?

I normally don't. I would make sure the patient is getting anticoagulated if indicated. I don't believe making the hemoglobin closer to normal in the setting of being anticoagulated increases thrombosis risk that much. I would shoot for a hemoglobin goal of 10-11.

I am not aware of large data support of refuting its use. The risks of low Hb, need for transfusion, risk of sensitization, underlying CAD, etc., would all drive the need to maintain higher Hb levels with some dose of ESA than without it. Do not think it is an absolute contraindication.