Background: Prothrombin time (PT) and international normalized ratio (INR) prolongation have traditionally been utilized as indications of the degree of coagulopathy in cirrhosis. Which is thought to be a hypocoagulable state. It most likely overestimates the risk of bleeding in people with liver disease. Despite the common misconception that liver cirrhosis increases the risk of bleeding, elevated INR levels may be able to predict presence of portal vein thrombosis (PVT) in cirrhotic patients, helping them to avoid the complications that come with it. Moreover, PVT may arise from a hypercoagulable state in cirrhosis that is not picked up by coagulation assays. Aim: To assess the value of elevated INR as a predictor of occurrence of PVT in patients with cirrhosis. Methods: This case control study was conducted at Tropical Medicine Department, Zagazig University Hospitals. This study included one hundred thirty four (134) individuals, divided into two groups: 67 cirrhotic patients with PVT (case group) and 67 cirrhotic patients without PVT (control group). Results: The case group had significantly elevated INR compared to the controls. INR was a strong predictor of PVT (AUC=0.737, p<0.001), with a cut off (>1.2) showing sensitivity of 80.6%, specificity of 53.7%, PPV of 63.5%, and NPV of 73.5%. Conclusion: In patients with liver cirrhosis, an elevated international normalized ratio can predict portal vein thrombosis. International normalized ratio shouldn't be validated as a potential predictor for bleeding in cirrhotic patients.