Overview of coagulopathy in patients with cirrhosis

Coagulopathy in patients with cirrhosis is complex. While there is often concern about an increased risk of bleeding in patients with cirrhosis, it is now recognised that these patients have precariously ‘rebalanced’ haemostasis that can shift to either a prothrombotic state or a bleeding state in certain clinical situations (eg disseminated intravascular coagulation [DIC], sepsis, kidney impairment).

Traditional markers of coagulation (international normalised ratio [INR], prothrombin time [PT]) do not accurately predict bleeding in patients with cirrhosis, and these patients may actually be at increased risk of thrombosis despite an elevated INR or PT.