In patients with end-stage renal disease on maintenance hemodialysis, coagulation abnormalities such as hypercoagulability and thrombosis are common. Thrombotic complications in uremic patients are frequent and include those occurring at the vascular access and in the coronary, cerebral, and retinal arteries. Data do not entirely clarify the mechanisms involved and further investigations are necessary. Here we show a summary of coagulation and fibrinolytic disorders in uremia and the novelties foreseen in molecular biology.