Patients with hepatic cirrhosis are uniquely at risk for both bleeding and clotting, making anticoagulation decisions complex. In this episode, we explore how cirrhosis alters coagulation, the pros and cons of LMWH, warfarin, and DOACs, and why INR isn’t a reliable guide. We also discuss the challenges of managing anticoagulation around procedures and how to individualize therapy in the face of limited evidence. Whether you're in training or practice, this is a must-listen for navigating one of medicine’s most nuanced dilemmas.