Platelet Dysfunction in Liver and Kidney Disease

Patients with liver or kidney disease exhibit complex hemostatic changes, including abnormalities in platelet count and function. Although patients frequently bleed, bleeding is often unrelated to and not predicted by platelet abnormalities. Likewise, routine platelet transfusion to correct platelet abnormalities does not appear to prevent bleeding. Patients also exhibit prohemostatic abnormalities such as increased von Willebrand factor levels and platelet activation, which may compensate for antihemostatic changes. Notably, thrombosis is a frequent complication in these patients. Here, we narratively review platelet abnormalities and their relation to clinical practice for bleeding and thrombosis in liver and kidney disease.