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Since most coagulation factors are produced by the liver (with the exception of factor VIII and von Willebrand factor) and cirrhosis causes thrombocytopenia and platelet dysfunction, patients with cirrhosis are at risk for coagulation problems. In cirrhosis, over time, a balance between procoagulant and anticoagulant factors usually develops.

Initially, there is an increased tendency for thrombosis, which causes 15 to 20% of patients with advanced cirrhosis to develop a portal vein thrombosis. This increased tendency for thrombosis causes microthrombi to form in distal branches of the portal veins. This leads to perfusion disorders in the liver and increases liver failure.

In more advanced forms of cirrhosis associated with infections, an increased tendency to bleed may eventually develop. An increased PT (INR) does not indicate an increased risk of bleeding, but is rather a parameter of the severity of the underlying liver disease.

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