Haemostasis associated with liver disease and liver transplantation

The production and regulation of components of haemostasis is largely dependent on liver function. Liver disease is associated with alteration of the coagulant:anticoagulant and fibrinolytic:antifibrinolytic balance as well as quantitative and qualitative alterations of the cellular components of haemostasis. In this article we have reviewed the nature and frequency of disturbed haemostatic function in patients with acute and chronic liver disease and during liver transplantation. The risk of haemorrhage and thrombosis, and mechanisms leading to these complications are reviewed and treatment strategies utilising blood component therapy and pharmacological manipulation of the coagulant and fibrinolytic systems are proposed. Finally, areas for further study are suggested so that rational effective therapeutic strategies can be developed.