Liver-related coagulopathy

In cirrhosis/advanced liver disease, hemostasis is REBALANCED: routine coagulation labs (INR) often look abnormal but do NOT reliably predict procedural bleeding, because pro- and anti-hemostatic changes offset (AASLD 2021; AGA 2019). Dental relevance: (1) INR alone is a POOR bleeding predictor in cirrhosis and there is NO target INR to 'correct'; (2) prophylactic plasma/FFP to lower INR is NOT recommended and may worsen portal hypertension; (3) no validated INR or platelet cutoff reliably identifies who will bleed — platelet thresholds (e.g. 30/50 x10⁹/L) come from procedural/interventional-radiology consensus, NOT validated dental cutoffs, and AASLD abstains from a routine preprocedural correction threshold; (4) clinical bleeding history is the most informative predictor and local hemostatic measures are the primary dental tool.