Abstract Background: Variceal bleeding isa majorcause of death in patients with cirrhosis. Von Willebrand factor (vWF) is a pro-tein released by endothelial cells (ECs), reflects EC activation. Levels of vWF had been discovered to be higher in people with liver cirrhosis; however, there is a scarcity of information about its role in prediction of portal hypertensive bleeding. Blood test measuring Von Willebrand factor-Ag level (vWF-Ag) com-bined with platelet count allowed the development of a novel prediction score, the von Willebrand factor/thrombocyte ratio (the VITRO score). Aim of Study: To assess the relationship between the von Willebrand factor and the VITRO score with variceal bleeding in cirrhotic patients. Patients and Methods: 42 cirrhotic patients and 19 healthy controls were included in the study. The patients were catego-rized into two groups: 21 cirrhotic patients with recent variceal bleeding and 21 cirrhotic patients without variceal bleeding. All patients underwent Laboratory tests including vWF/Ag and upper endoscopy. vWF level andVITRO scorewere compared-between both groups and 19 normal controls. Results: Patients with variceal bleeding had significantly higher level of vWF (12ng/ml) compared to patients without bleeding (9.2ng/ml) and normal controls (9.6ng/ml). Patients with variceal bleeding also had higher VITRO score (0.174), compared to patients without bleeding (0.058) and normal con-trols (0.037), the difference was statistically significant. Conclusion: We suggest that the vWF and VITRO score can be used as noninvasive biomarkers for the prediction of variceal bleeding in patients with liver cirrhosis with high sen-sitivity and specificity.