Hepatology. 2020 Jul 4. doi: 10.1002/hep.31451. Online ahead of print.
Historically, patients with liver disease were considered to have a bleeding tendency that was a consequence of changes in their hemostatic system. An important consequence of this concept is the ever-ongoing policy of prophylactic blood product transfusion prior to invasive procedures aimed to reduce bleeding risk. However, it is increasingly acknowledged that although bleeding in patients with liver diseases can be the consequence of a (temporal) hypocoagulable state, it is frequently unrelated to hemostatic failure and rather caused by portal hypertension (e.g., variceal bleeding) or inadvertent laceration of a blood vessel (e.g., during liver biopsy or paracentesis).