Hemostasis in Liver Disease

The coagulopathy of liver disease is often multifactorial, and symptoms may be minimal for the degree of coagulopathy until the liver disease is very severe. Decreases in production of coagulation factors and associated disturbances in biliary function cause abnormalities that lead to both prothrombotic and hemorrhagic diatheses. Platelet counts are decreased due to decreased thrombopoiesis from the lack of thrombopoietin as well as increased destruction from hypersplenism. The pathologies that cause the hepatopathy often have an effect on hemostasis: alcohol, warfarin, autoimmune disorders, and hepatitis all have direct coagulopathic consequences. In this chapter, we hope to help the reader understand the intricate balance between clotting and bleeding in liver disease and to interpret the results of both routine and specialized coagulation testing in the assessment of the patient with liver disease that will result in optimal management for these complex patients.