Hemostatic Problems in Chronic and Acute Liver Disease

Patients with liver disease frequently have complex alterations in their hemostatic system, including thrombocytopenia and platelet function defects, low levels of most pro‐ and anticoagulants, and low levels of fibrinolytic proteins. Whereas routine laboratory tests of hemostasis suggest patients with liver disease to have a bleeding tendency, recent clinical and laboratory studies have shown that patients with liver disease are actually in a hemostatic balance due to the concomitant decrease of pro‐ and antihemostatic mechanisms. However, the hemostatic balance in these patients is precarious, and patients may experience bleeding or thrombotic complications.