The liver is a vital organ that maintains hemostatic balance. It is the primary site of production for most coagulation factors, including fibrinogen and factors II, V, VII, IX, X, and XI, as well as natural anticoagulants such as protein C, protein S, and antithrombin. In individuals with advanced liver disease, significant disturbances in coagulation homeostasis occur, raising the risk of both thrombotic and bleeding complications. Liver cirrhosis is linked to complex hemostatic abnormalities, including decreased platelet count, elevated vWF levels, reduced hepatic production of procoagulant proteins and their inhibitors, and alterations in fibrinolytic activity. In cirrhosis, hepatocellular dysfunction results in decreased production of procoagulant proteins, which generally indicates a bleeding tendency. For patients with liver disease, preoperative hemostasis assessment is essential.