Background/Objectives: Cirrhosis is characterized by a fragile and unstable hemostatic balance, predisposing patients to both hemorrhagic and thrombotic complications, particularly in the context of chronic liver disease (CLD). This dual risk presents significant challenges for clinical management and complicates therapeutic decisions. The objective of this study was to evaluate coagulation profiles in cirrhotic patients and their association with bleeding and thrombotic events, with the aim of identifying predictors of hemostatic complications. Methods: A retrospective study was conducted on patients with cirrhosis admitted to a tertiary liver transplant center between February 2022 and March 2024. Inclusion criteria required the availability of extended coagulation data in medical records. Demographic, clinical, and laboratory parameters were collected and analyzed to assess associations with thrombotic events and upper gastrointestinal bleeding (UGIB). Results: Fifty-nine patients met the inclusion criteria (mean age 53.4 ± 10.3 years), of whom 62.7% were male. UGIB occurred in 18.6% of patients, thrombotic events in 20.3%, and portal vein thrombosis in 16.9%. Routine coagulation parameters, including international normalized ratio (INR) and activated partial thromboplastin time (APTT), did not demonstrate significant predictive value for either bleeding or thrombotic events. Conclusions: Patients with cirrhosis are simultaneously at risk for both bleeding and thrombosis, reflecting the fragile and complex nature of hemostatic regulation in advanced liver disease (ALD). Standard laboratory coagulation tests are inadequate for accurate risk stratification in this setting. These findings highlight the limitations of conventional coagulation tests and support the need for further studies evaluating advanced hemostatic assessment tools in patients with cirrhosis.

Inflammatory bowel disease (IBD), encompassing Crohn’s disease (CD) and ulcerative colitis (UC), is a chronic immune-mediated condition with substantial global burden and rising incidence, requiring an expanding range of advanced therapies. This focused narrative review examines the mechanistic rationale, comparative clinical evidence, and translational implications of approved and emerging targeted therapies for adult IBD. A structured literature search was conducted in PubMed, Scopus, and Web of Science for publications from January 2021 to March 2026. Thirty-eight articles were selected as the core evidence set with landmark trials and clinical guidelines added when needed for historical or practice context. Evidence was synthesised narratively, with an explicit distinction between direct head-to-head comparisons, placebo-controlled trials, indirect network comparisons, and observational data. In UC, VARSITY showed higher week-52 clinical remission and endoscopic improvement with vedolizumab than adalimumab; in CD after anti–tumour necrosis factor (anti-TNF) failure, SEQUENCE showed risankizumab noninferior to ustekinumab for week-24 clinical remission and superior for week-48 endoscopic remission. Agents targeting tumour necrosis factor-like cytokine 1A (TL1A) have shown encouraging activity in phase 2/2b trials, but long-term effectiveness and safety remain uncertain. The current evidence supports mechanism-informed rather than biomarker-defined treatment selection. Confidence in comparative conclusions is greatest when supported by direct randomised evidence, whereas observational and indirect comparisons require caution because of confounding, heterogeneity, and differences in populations and outcome definitions. Clinical translation therefore requires the integration of the disease phenotype, prior treatment exposure, safety risks, and patient preference, with objective reassessment after therapy initiation.