Published online Jun 21, 2021. doi: 10.3748/wjg.v27.i23.3290
Peer-review started: January 28, 2021
First decision: March 14, 2021
Revised: March 17, 2021
Accepted: May 20, 2021
Article in press: May 20, 2021
Published online: June 21, 2021
Core Tip: Despite having specific alterations in all hemostasis phases and, thus, considered naturally anticoagulated, cirrhotic patients have, in fact, balanced hemostasis. However, this balance may be disturbed by different factors, and the result may vary from devastating bleeding to massive thrombosis. Conventional laboratory tests failed to predict these events. Viscoelastic tests appear to offer a better, global view of hemostasis in these patients. They have been used to assess bleeding risk before invasive interventions and for a precocious use of blood product transfusions.