Spontaneous bleeding or thrombosis in cirrhosis: What should be feared the most?

Core Tip

Core tip: The two-faced, dynamic, and fragile hemostatic and coagulation system of patients with cirrhosis is of increasing interest. Thrombotic complications, and not only the well-known bleeding complications such as gastroesophageal bleeding, are now recognized complications of cirrhosis. Whether confined to the portal vein, due to venous stasis but also to other yet poorly characterized local as well as systemic factors, or in the presence venous thromboembolism, these complications warrant prevention and treatment with anticoagulation. Future clinical studies, as well as the broader implementation of point-of-care instruments and results from studies using global coagulation assays will outline the best strategies, tailored to each patient according to the severity of liver disease and the particular hemostatic alterations present at a given timepoint.