Abnormalities of hemostasis in chronic liver disease: Reappraisal of their clinical significance and need for clinical and laboratory research

The derangement of hemostasis in patients with chronic liver disease has long been thought to be causally related to the bleeding events seen in these patients. However, the relatively poor correlation between bleeding and the peripheral indices of hemostasis together with the recent findings of the literature that thrombin generation as well as platelet adhesion are normal in these patients challenge this concept and question the usefulness of conventional tests in assessing the hemorrhagic risk, as well as the appropriateness of therapeutic strategies meant to correct abnormal hemostasis tests. This article reviews the abnormalities of primary hemostasis (interaction between platelets and vessel wall), coagulation (thrombin generation) and fibrinolysis in patients with chronic liver disease and proposes areas needing further clinical and laboratory research.