The concept of rebalanced hemostasis in patients with liver disease. In healthy persons (A), hemostasis is in a solid balance. In patients with liver disease (B and table), concomitant changes in pro- and antihemostatic pathways result in a “rebalance” in the hemostatic system. Rebalance in the hemostatic system occurs at the level of primary and secondary hemostasis, and in the fibrinolytic system. This new balance, however, presumably is less stable compared with the balance in healthy volunteers, and may thus more easily tip toward either bleeding or thrombosis. Modified from Warnaar et al⁶⁹  with permission from Wolters Kluwer Health.