End stage liver disease: A delicate balance of bleeding and thrombosis

It is well known that the coagulation processes may be seriously altered in end-stage liver disease (ESLD). Historically, hepatatopathic patient has always been considered auto- anticoagulated; however, recent acquisitions have led to considering this patient “rebalanced” towards a condition of labile and delicate hemostatic balance, due to a concomitant decrease of procoagulative and anticoagulative factors.These problems become more relevant in the case of surgical procedures and, even more, during liver transplantation (LT), a procedure that may be associated with large fluid shifts, huge blood losses and major hemodynamic changes.