This chapter discusses bleeding and thrombotic issues in patients with renal and liver disease. Causes, testing for, and management of both issues are discussed. While it has been accepted for years that patients with liver disease are at risk of bleeding, recently there has also been the realization that for most patients this hazard has been overstated and that paradoxically thrombosis may also be risk. Most bleeding in liver disease patients is due to mechanical reasons such as a ruptured varix rather than an underlying coagulopathy. In addition, classic tests of coagulation fail in many patients to fully assess their hemostatic capacity.
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