Relevance of clotting tests in liver disease

Liver disease is associated with impairment of the haemostatic function due to the abnormal and decreased synthesis of the clotting factors. It is thus only logical to have considered assessment of the clotting profile (to include prothrombin time (PT) and activated partial thromboplastin time (aPTT)) to be an integral part of the comprehensive assessment of a patient who presents with liver impairment. Laboratory abnormalities of coagulation are considered to be a predictive risk factor for bleeding, but patients with liver disease do not have bleeding pattern as those who have coagulation factor deficiencies. Recent experiments have cast doubts over the use of PT and aPTT as a marker of bleeding in liver disease and the use of such tests to decide the need for plasma replacement before interventions like liver biopsy. This article reviews the relevance of the clotting profile in liver disease, the other factors involved in the haemostatic failure associated with it, and the technical problems in the interpretation of these results. Most importantly, it stresses the need for more trials to help us guide the management of bleeding in patients with liver impairment.