What is the effect of liver disease on bleeding risk?

• A. Decreases bleeding risk
• B. No change
• C. Increases bleeding risk due to impaired production of clotting factors
• D. Increases bleeding risk due to increased platelet production

Answer: (C)

Liver disease disrupts the body’s ability to form clots by reducing the production of most clotting factors. The liver makes key factors such as II (prothrombin), VII, IX, and X, along with fibrinogen and other components of the coagulation cascade. When the liver is damaged, these clotting factors fall, leading to a longer clotting time (often reflected as an elevated INR/PT) and a higher tendency to bleed. Platelet numbers and function can also be affected because thrombopoietin, which helps drive platelet production, is produced by the liver; portal hypertension can further reduce platelets by splenic sequestration. The combination of decreased clotting factors (and sometimes lower platelets) is why bleeding risk is increased in liver disease.

Other options don’t fit: bleeding risk is not decreased, there is a change in coagulation rather than no change, and liver disease does not cause increased platelet production.