Inclusion Criteria:  - Consecutive patients with cirrhosis or ACLF undergoing their first session of dialysis  Exclusion Criteria:  Age <12 or > 75 years Hepatocellular Carcinoma Recent history of blood product transfusion in the last 7 days History of antiplatelets, antifibrinolytics or antithrombotics Active untreated Sepsis/DIC Any evidence of active bleed secondary to coagulopathy Pregnancy Comorbidities associated with poor outcome (Extrahepatic neoplasia, severe cardiopulmonary disease defined by a New York Heart Association score >3, or oxygen/steroid-dependent chronic obstructive pulmonary disease ) Refusal to participate in the study.