Abnormalities of hemostasis and bleeding in chronic liver disease: the paradigm is challenged

Chronic liver disease is characterized by a global hemostatic defect including platelet–vessel wall interaction (primary hemostasis), coagulation and fibrinolysis that may cause abnormalities of the relevant laboratory tests. The causal relationship between abnormal tests and bleeding has been widely accepted, despite the fact that abnormal tests are poorly associated with the timing and incidence of actual bleeding. In this article, we review...