Tests of coagulation in liver disease.

The complex coagulation defect secondary to chronic liver disease is considered responsible for the bleeding problems that often are associated with the disease. Accordingly, clinicians order laboratory tests to assess the risk of bleeding and rely on these results to make decisions about the management of the associated coagulation disturbances. Recent data, however, indicate that the abnormality of coagulation in stable cirrhosis is more a myth than a reality and may help explain why the prolonged global coagulation tests are poor predictors of bleeding in this setting. Alternative tests more closely mimicking what occurs in vivo should be developed and investigated in appropriate clinical trials to determine their value in the management of bleeding in cirrhosis.