Haemostasis and thrombosis in liver disease

Br J Haematol. 2010 Feb;148(4):507-21. doi: 10.1111/j.1365-2141.2009.08021.x. Epub 2009 Dec 8.


Liver disease impacts on both primary and secondary haemostatic mechanisms and historically these changes were thought to underpin the bleeding diathesis. However, bleeding complications in patients with liver disease are unpredictable, with the majority of haemorrhagic episodes occurring as a result of porto-systemic varices. Thrombosis is an increasingly recognised complication and systemic hypercoagulability may contribute to the development of parenchymal extinction and accelerated hepatic fibrosis. Routine laboratory tests do not reliably predict the risk of haemorrhage and the optimal management strategy to avert potential bleeding complications is yet to be established. There may be a future role for global coagulation assays, such as thrombelastography and thrombin generation, in both stratifying the risk of bleeding and guiding management of these patients.

Publication types

  • Review

MeSH terms

  • Blood Coagulation Disorders / drug therapy
  • Blood Coagulation Disorders / etiology
  • Blood Coagulation Factors / biosynthesis
  • Blood Coagulation Tests / methods
  • Hemorrhage / etiology
  • Hemostasis / physiology*
  • Humans
  • Liver Diseases / blood*
  • Liver Diseases / complications
  • Liver Diseases / surgery
  • Liver Transplantation
  • Prognosis
  • Thrombosis / etiology*


  • Blood Coagulation Factors