Which statement best describes major bleeding risks in cirrhosis?

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Major bleeding risk in cirrhosis comes from two intertwined problems: the liver’s impaired ability to make clotting factors and the development of portal hypertension that leads to variceal bleeding. When the liver is damaged, it doesn’t produce enough clotting factors, so the blood’s ability to clot is reduced, which raises the tendency to bleed. Separately, portal hypertension causes veins in the esophagus and stomach to distend into varices; these varices are fragile and prone to rupture, causing major hemorrhage. The combination of coagulopathy and variceal risk explains why this statement best describes the bleeding danger in cirrhosis.

An idea often seen in other options is incorrect: platelet function is not increased—cirrhosis typically brings thrombocytopenia and platelet dysfunction, which worsens bleeding risk. Portal hypertension does not reduce variceal bleeding risk; it increases it. And the liver does not increase synthesis of clotting factors in cirrhosis; it decreases their production.