Venous thromboembolism in chronic liver disease.

The liver plays a central role in the maintenance of a normal hemostatic balance by synthesizing several factors belonging to the pathways of coagulation, anticoagulation, and fibrinolysis. It is thereby unsurprising that patients with chronic liver disease (CLD) or cirrhosis may experience a kaleidoscope of hemostatic disorders. A bleeding tendency represents the most frequent and clinically severe hemostatic complication of CLD or cirrhosis. Perhaps less anticipated, growing evidence now suggests that a procoagulant state may be also associated with CLD, so that patients with CLD or cirrhosis, irrespective of its etiology, rather than be "naturally anticoagulated" might also experience a large spectrum of spontaneous or unprovoked venous thrombotic complications. The clinical significance of an increased risk of venous thromboembolism in CLD is an important topic for future research, and the initiation of new randomized studies of potential treatments for this complication is needed.