Time to change the classical vision of coagulation in liver disease: from the balance disequilibrium to systems biology network modeling.

The longstanding dogma that patients with liver disease have a hemostasis related bleeding tendency is neglected from the last 10 years however, despite this tremendous change of paradigm no longer progress had been made in this field. A mathematical model is a description of a system using mathematical concepts and language. Mathematical models are able to analyze large amount of data and they can make predictions about behavior. Mathematical models are used in the social sciences, engineering as well as in medicine. Blood coagulation in patients with liver disease is difficult to predict due to its network complexity and moreover, due to all factors that potentially can impact hemostasis in this patient population outside of the coagulation itself, as portal hypertension, endothelial dysfunction and renal injury, between others. Although ambitious and extremely complex, the aforementioned approach requires a substantial investment of multidisciplinary human and technologic resources, this holistic overview is the closest to the real situation. The ability of the mathematical modeling to predict bleeding and thrombotic complications in patients with liver disease deserves to be investigated.