Laboratory tests of hemostasis. The relation to hemorrhage in liver disease

In PATIENTS with liver disease one or more abnormalities of hemostasis can frequently be demonstrated in the laboratory.1Although it is generally believed that these abnormalities predispose to hemorrhage, it has not been clearly established that hemostatic defects are more common or more severe in bleeding than in nonbleeding patients with liver diesase. The many comprehensive reports of hemostasis in liver disease2-7have not systematically related laboratory tests to clinical hemorrhage. Similarly, previous studies of hemostatic defects in patients with bleeding8-11do not present comparable data on nonbleeding cirrhotics. Correlation between laboratory tests and clinical bleeding is further complicated by the difficulty in classifying minor degrees of hemorrhage. In the present report hemostatic studies were performed on a consecutive series of patients with cirrhosis admitted to a medical ward and were correlated with the incidence of major hemorrhage, defined as bleeding sufficiently severe to require transfusion. Materials