The hemostatic and thrombotic complications of liver disease

Eur J Haematol. 2021 Oct;107(4):383-392. doi: 10.1111/ejh.13688. Epub 2021 Jul 29.


Hepatic cirrhosis leads to numerous hematologic derangements resulting in a complex and tenuously rebalanced hemostatic milieu. The utility of common hematologic tests including the INR and aPTT in assessing hemostatic and thrombotic risk in patients with cirrhosis is limited, and consensus on transfusion thresholds and proper management of thrombotic complications continues to evolve. This review summarizes the pathophysiology of key derangements of hemostasis including those of platelets, von Willebrand factor, pro- and anticoagulation factors, and fibrin. Additionally, the pathogenesis, consequences, optimal management, and prevention of major thrombotic and bleeding complications in cirrhosis arte discussed.

Keywords: blood coagulation; hemostasis; humans; liver cirrhosis; thrombosis.

Publication types

  • Review

MeSH terms

  • Anticoagulants / therapeutic use*
  • Blood Platelets / drug effects
  • Blood Platelets / metabolism
  • Blood Platelets / pathology
  • Blood Transfusion / methods
  • Fibrinogen / antagonists & inhibitors
  • Fibrinogen / metabolism
  • Hemostasis / drug effects
  • Heparin, Low-Molecular-Weight / therapeutic use*
  • Humans
  • Liver Cirrhosis / blood*
  • Liver Cirrhosis / complications
  • Liver Cirrhosis / pathology
  • Liver Cirrhosis / therapy
  • Thrombosis / blood*
  • Thrombosis / complications
  • Thrombosis / pathology
  • Thrombosis / therapy
  • von Willebrand Factor / metabolism


  • Anticoagulants
  • Heparin, Low-Molecular-Weight
  • von Willebrand Factor
  • Fibrinogen