What are the factors that you would consider for the use of ESA in patients with anemia of CKD with a history of stroke or TIA?

Large clinical trials of ESA have indicated increased stroke risk with these medications with TREAT reporting the highest stroke incidence. In this study, "baseline history of cerebrovascular disease was a strong predictor of experiencing a stroke during follow-up; patients with a history of stroke or transient ischemic attack had twice the risk of stroke compared with patients without such a history at baseline (odds ratio, 2.00; 95% confidence interval, 1.36–2.94)" (Winkelmayer, PMID 22184042). Data including an analysis of the CHOIR study from 2013 also suggest that a high weekly dose of erythropoietin (>10,000 units) may be linked to increased stroke risk. A meta-analysis confirmed that a high dose of EPO may be linked to an increased r...