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Background and study aims Bleeding and thrombotic complications are common problems in patients with chronic liver disease (CLD). The aim of the present study was to evaluate the level of soluble P (sP)-selectin and P-selectin glycoprotein ligand-1 (PSGL-1) (CD162) expression on neutrophils among patients with CLD and to clarify the role of their interaction, by measuring the platelet leucocyte aggregates, on the clinical outcome of the haemostatic balance in those patients. We also investigated the hypothesis that the balance between platelet activation and endothelial biological function is impaired. Patients and methods sP-selectin and thrombomodulin (TM) levels were measured by enzyme-linked immunosorbent assay (ELISA) and flowcytometric detection of CD162 was performed. Platelet–leucocyte aggregation (PLA) in whole blood was measured as positive for CD41a and CD45 in 66 CLD patients divided into the portal vein thrombosis group (PVT) (n = 25), the haematemesis group (n = 21) and the haemostatically stable group (n = 20). Results sP-selectin was significantly elevated in all patient groups. Decreased surface expression of CD162 on neutrophils was detected in all patients’ groups. PLA was statistically significantly increased in the PVT group. TM was statistically significantly increased in the PVT, haematemesis and haemostatically stable groups. Conclusion PLA may play a role in the unique PVT outcome of the haemostatic balance in a group of patients whose credentials of hyperdynamic portal circulation predispose them to bleeding rather than thrombosis. Consequently, P-selectin-targeted therapy may be used to prevent this complication.