Rebalanced hemostasis in chronic liver disease. Primary hemostasis: high VWF levels and low ADAMTS 13 levels counteract defects in primary hemostasis. Coagulation: reduced levels of procoagulant factors are balanced by a parallel decline in anticoagulant factors. Fibrinolysis: fibrinolysis is rebalanced by parallel changes in profibrinolytic and antifibrinolytis proteins. VWF indicates von Willibrand factor; ADAMTS 13, a disintegrin & metalloproteinase with thrombospondin type 1 motif 13; PC, protein C; PS, protein S; AT, antithrombin; * does not occur consistently in chronic liver disease; and **end-stage liver disease.