Coagulation disorders in patients with chronic liver disease: A narrative review

Patients with cirrhosis present a highly vulnerable and rebalanced hemostasis state. Assessing the bleeding risk in these patients is complex. It is essential to recognize that conventional coagulation tests do not adequately reflect the true risk of bleeding or thrombosis. The detailed understanding of this balance and the application of more precise diagnostic tools, such as viscoelastic tests that can more accurately evaluate their coagulation status, facilitate clinical management and can improve the results in these patients. The haemorrhagic risk of this group of patients is conditioned by specific factors of liver disease, such as portal hypertension and altered haemostatic status, and by systemic factors like the presence of infections and kidney disease, which are independent predictors of bleeding during high-risk procedures. These concepts and the recommendations from the most recent clinical practice guidelines are reviewed in this article.