Knowledge Portal
Haemostasis in liver disease
Haemostasis in advanced liver disease is rebalanced but fragile: prohaemostatic and antihaemostatic pathways are altered together. An elevated INR or low platelet count therefore does not translate directly into bleeding risk, while thrombosis remains possible. Assessment should be tied to the clinical context, the procedure and destabilising factors such as infection, renal failure and ACLF, with blood products used for a defined indication rather than to normalise routine laboratory results.
Key information
Guidelines and position statements
Relevant clinical practice guidelines, practice guidance, consensus statements and position papers from professional bodies and expert groups.
EASL Clinical Practice Guidelines on bleeding and thrombosis in cirrhosis
EASL · guideline · 2022
Practical recommendations for procedures, active bleeding, thromboprophylaxis and thrombosis.
Open resource →Further context
Other useful resources
Selected review articles, practical explainers, expert discussions, reference sites and e-learning from established providers.
Hemostasis in Liver Disease Within Patient Blood Management: A Scoping Review of the Current Literature
Czempik PF, et al. Journal of Clinical Medicine. 2026;15(9):3296.
A current overview connecting haemostatic concepts with patient blood management.
Open resource →How to manage hemostasis in patients with liver disease during interventions
Roberts LN. ASH Education Program. 2023;2023(1):274–281.
A practical, case-based review of procedural risk and when correction may or may not be useful.
Open resource →How to assess hemostasis in patients with severe liver disease
Lisman T. ASH Education Program. 2023;2023(1):267–273.
A clear explanation of rebalanced haemostasis and the limitations of conventional coagulation tests.
Open resource →Back to Basics: The Conundrum of Coagulopathy in Cirrhosis
AASLD Liver Fellow Network · clinical explainer · 2024
An accessible introduction to procedural bleeding risk and the limits of INR and platelet count.
Open resource →Should anticoagulants be given to patients with cirrhosis to improve outcome?
EASL Studio · expert discussion
A focused discussion of anticoagulation, survival and liver-related outcomes.
Open resource →Coagulopathy
Critical Care Reviews · curated review collection
A wider critical-care collection that helps place cirrhotic haemostasis alongside other ICU coagulopathies.
Open resource →