Liver Disease; Hemostasis and Coagulation Disorders

Hemostasis is a complex and well controlled process that requires the interplay of multiple players to generate localized clot formation to prevent or stop bleeding. The liver plays a critical role in hemostasis as it synthetizes most of the proteins involved in coagulation and fibrinolysis and produces thrombopoietin that regulates platelet production. Furthermore, the liver is involved in clearance of many hemostatic and fibrinolytic components. Liver diseases induce major modifications in hemostasis and are associated with endothelial activation. As a result, a complex coagulopathy may develop in patients with liver diseases where both bleeding and thrombosis can ensue. This article presents coagulation changes occurring in patients with liver diseases, thrombosis and bleeding risk as well as insight into the management of anticoagulation and of invasive procedures in these patients.