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Haemostatic balance in patients with end-stage cirrhosis: low protein C is the predominant coagulant protein deficiency.

We read with great interest the article by Baccouche et al. [1] on the rebalance of the coagulation system in patients with cirrhosis. Nowadays, there is intense research on the changes in primary haemostasis and the presence of procoagulant imbalance in the setting of cirrhosis [2,3]. However, the role of liver synthetic capacity per se in the haemostatic balance remains unclear. Specifically, it is unknown whether certain liver-produced procoagulant or anticoagulant factors are independently related to increasing liver disease severity.