Bleeding and Thrombotic Risk in Cirrhosis: Hemostatic Profiles from a Single-Center Experience

Background/Objectives: Cirrhosis is characterized by a fragile and unstable hemostatic balance, predisposing patients to both hemorrhagic and thrombotic complications, particularly in the context of chronic liver disease (CLD). This dual risk presents significant challenges for clinical management and complicates therapeutic decisions. The objective of this study was to evaluate coagulation profiles in cirrhotic patients and their association with bleeding and thrombotic events, with the aim of identifying predictors of hemostatic complications. Methods: A retrospective study was conducted on patients with cirrhosis admitted to a tertiary liver transplant center between February 2022 and March 2024. Inclusion criteria required the availability of extended coagulation data in medical records. Demographic, clinical, and laboratory parameters were collected and analyzed to assess associations with thrombotic events and upper gastrointestinal bleeding (UGIB). Results: Fifty-nine patients met the inclusion criteria (mean age 53.4 ± 10.3 years), of whom 62.7% were male. UGIB occurred in 18.6% of patients, thrombotic events in 20.3%, and portal vein thrombosis in 16.9%. Routine coagulation parameters, including international normalized ratio (INR) and activated partial thromboplastin time (APTT), did not demonstrate significant predictive value for either bleeding or thrombotic events. Conclusions: Patients with cirrhosis are simultaneously at risk for both bleeding and thrombosis, reflecting the fragile and complex nature of hemostatic regulation in advanced liver disease (ALD). Standard laboratory coagulation tests are inadequate for accurate risk stratification in this setting. These findings highlight the limitations of conventional coagulation tests and support the need for further studies evaluating advanced hemostatic assessment tools in patients with cirrhosis.