Cirrhosis is characterized by varying degrees of alterations of the different components of hemostasis, including thrombocytopenia, reduction of procoagulant factors, overactivation of the fibrinolytic system, and a precarious hemostatic equilibrium that can easily tilt towards bleeding. Predicting the risk of spontaneous bleeding from nonvariceal sites, variceal bleeding, and hemorrhagic complications associated with surgery or invasive procedures is a formidable challenge faced by clinicians caring for cirrhosis patients, and standard assays have demonstrated a poor correlation with episodes of bleeding. While new tests evaluating different components of coagulation as well as global assays are increasingly available and used to guide therapeutic approaches, there is still no optimal method to assess bleeding risk, and a combination between severity of liver disease, the presence of ongoing infection or renal insufficiency, as well as the type of bleeding itself seems to still be very important in evaluating the individual patient's risk.