Case Report of a Patient Treated With Acenocumarol Awaiting Orthotopic Liver Transplant: Perioperative Coagulation Management and Risk for Hepatic Artery Thrombosis

•We report a case of a patient treated with Acenocumarol who received PCC based on preprocedure international normalized ratio before orthotopic liver transplant who developed intraoperative and early postoperative hepatic artery thrombosis.•A new concept of rebalanced hemostasis in end-stage liver disease supposes a challenge for orthotopic liver transplant teams who face difficult decisions to improve hemostasis and avoid both bleeding and thrombotic complications in the perioperative setting of these patients.•This case highlights the fragile balance of hemostasis in patients with end-stage liver disease and opens up a field of debate about the correct preoperative management of coagulation in end-stage liver disease in general and previous OLT in special.