Patients with chronic liver disease (CLD) experience complicated hemostatic alterations that impact all facets of coagulation, including the formation and disintegration of clots. Although it is a widely held idea that liver disease raises the risk of bleeding, thrombosis and hypercoagulability are also frequently linked to liver disease. The coagulation system shows signs of “rebalancing” in compensated liver disease, which can be influenced by a number of internal and external variables that lead to thrombosis or bleeding. Events such as bacterial infections and kidney failure can cause significant hemostatic changes that increase the risk of bleeding diathesis. Therefore, patients experiencing decompensation, infections, or acute-on-chronic liver failure (ACLF) are at a heightened risk of bleeding. Because conventional coagulation tests (CCTs) do not offer information on the interplay between different blood components, the rate of clot formation, the strength of the clot, or thrombolysis, they are unable to accurately reflect the hemostasis derangement in CLD. Global coagulation assays like thrombin generation and viscoelastic point-of-care (POC) devices better reflect the interaction between procoagulants, anticoagulants, platelets, and the fibrinolytic system. This chapter summarizes the changes in hemostasis in CLD, the limitations of conventional laboratory tests that are used to assess bleeding risk, and clinical implications for preventing and managing bleeding.