Much has changed since the characterization of the wide spectrum of abnormalities in the coagulation system in patients who have acute and chronic liver disease. With inherent limitations of conventional laboratory measures of coagulation in liver disease, it is now incumbent on us to explore how best to apply (or withhold) specific agents in specific situations. This will clearly require well focused translational research to understand and bring into sharp focus the various problems present, from dysfibrinogen to endogenous heparinoids, to uremia, to hyperfibrinolysis and even to unrecognized hypercoagulable conditions. The challenge lies ahead.