Influence of continuous veno-venous hemofiltration on argatroban clearance in a patient with septic shock

Sir: Argatroban, a direct thrombin inhibitor approved for heparin-induced thrombocytopenia (HIT), is primarily metabolized by the liver. Thus, dose adjustments are not recommended in renal failure [1, 2]. We report a patient with HIT and multiple organ dysfunction in whom anticoagulation by argatroban appeared to be substantially influenced by continuous veno-venous hemofiltration (CVVH). A 54-year-old woman with a history of rheumatoid arthritis and steroid therapy as well as peripheral arterial disease was admitted to