Inclusion Criteria:  Age 18-65 years ACLF, as diagnosed by CANONIC/ APASL criteria . Upper gastrointestinal bleeding  Exclusion Criteria:  Current therapy: Recent blood or blood component transfusion in the last 2 weeks. HIV positive/ AIDS patients Patients requiring antiplatelet therapy, Renal insufficiency requiring dialysis Active malignancy within the last 5 years Patient with other neurological disease and metabolic disorders, unbalanced heart failure and/or respiratory failure or end-stage renal disease Administration of anticoagulants, antifibrinolytics, Not willing to participate in the study