Causes of the hemostatic changes in patients with liver disease. The multiple changes that either reduce or promote hemostasis can be attributed to 4 mechanisms. (1) A reduced synthetic capacity of the liver results in decreased levels of many proteins involved in hemostasis. Moreover, decreased hepatic synthesis of thrombopoietin contributes to thrombocytopenia. (2) Systemic intravascular coagulation results in consumption of platelets and hemostatic factors. (3) Systemic activation of endothelial cells results in increased release or production of hemostatic factors. (4) Increased platelet pooling in the enlarged spleen may contribute to thrombocytopenia.