LIVER: Edited by Don C. RockeyCoagulation testing and management in liver disease patientsStotts, Matthew J.; Davis, Jessica P.E.; Shah, Neeral L.Author Information Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, Virginia, USA Correspondence to Matthew J. Stotts, MD, MPH, University of Virginia, Charlottesville, VA, USA. Tel: +1 434 924 2959; fax: +1 434 244 9445; e-mail: email@example.com Current Opinion in Gastroenterology: May 2020 - Volume 36 - Issue 3 - p 169-176 doi: 10.1097/MOG.0000000000000635 Buy Metrics Abstract Purpose of review The present article aims to provide clinicians with an overview of coagulation testing in individuals with liver disease, to discuss available procoagulants and the rationale for their use, and to provide management strategies in a variety of common clinical scenarios. Recent findings Clinicians and researchers are gaining an increased understanding of the shortfalls of assessing bleeding risk using traditional tests of coagulation. The use of global tests of clot formation, including viscoelastic testing and thrombin generation analysis, continues to evolve and guide the management of these patients. Summary Abnormal coagulation testing in individuals with cirrhosis leads to a variety of difficult clinical scenarios that can be challenging for practitioners. With advanced liver disease, changes in the traditional tests of hemostasis such as the international normalized ratio reflect decreased synthesis of procoagulant factors but do not capture concomitant decreases in anticoagulant factors. In this setting, transfusion thresholds targeting platelet and fibrinogen goals may provide an effective strategy to optimize clot formation. Global tests of clot formation provide practical information to clinicians and can help guide decision making, although optimal target levels have not been validated. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.