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To Clot or Not to Clot

Understanding Coagulopathy in Liver Disease

Wanderer, Jonathan P., MD, MPhil; Nathan, Naveen, MD

doi: 10.1213/ANE.0000000000002686
Infographics: Infographic

Vanderbilt University School of Medicine (

Northwestern University Feinberg School of Medicine (

The Infographic is composed by Jonathan P. Wanderer, MD, MPhil, Vanderbilt University School of Medicine (, and Naveen Nathan, MD, Northwestern University Feinberg School of Medicine ( Illustration by Naveen Nathan, MD.

The authors declare no conflicts of interest.



One of the hallmarks of end-stage liver disease is the manifestation of coagulopathy induced by a change in normal liver function, which disrupts the careful balance between bleeding and clotting. This can induce a physiological state where a patient is prone to abnormal bleeding, abnormal clotting, or both of those states together. In this infographic, we review the function of the normal liver in maintaining hemostasis and describe some of the physiological dysfunction that can be induced by end-stage liver disease.

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1. Forkin KT, Colquhoun DA, Nemergut EC, Huffmyer JL. The coagulation profile of end-stage liver disease and considerations for intraoperative management. Anesth Analg. 2018;126:4661.
    © 2018 International Anesthesia Research Society