To explore the effect of renal insufficiency and maintenace hemodialysis on hemoststic parameters, thirty chronic renal failure (CRF) patients under maintenance hemodialysis (HD) were investigated. The extended hemostatic assessment included study of factor VIIa-rTF coagulant activity by clotting assay, level of factor VII antigen VII Ag by ELISA technique, and assessment of monocyte procoagulant activity by measuring its tissue factor expression by flow cytometry before and immediately after dialysis. Results showed that thrombotic events were reported in 40% of patients. CRF patients are more liable to thrombotic complications reflected by the increased monocyte tissue factor expression and increased activation of tissue factor pathway and factor VII Ag. Moreover the maintenance HD process significantly affected the levels of activated factor VII, monocyte tissue factor expression, and factor VII antigen with possible role in thrombotic events. CRF patients under maintenance HD especially with recurrent vascular access thrombosis should have extended coagulation profile study including monocyte tissue factor expression, assay of (VIIa-rTF), factor VII antigen, protein C, protein S, factor V leiden, and lupus anticoagulants. In conclusion, Thrombotic events were reported in 40% of CRF patients under maintenance hemodialysis. Vascular access thrombosis has been a frequent cause of morbidity in patients on hemodialysis, and diagnostic evaluation should include a hypercoagulability profile. Maintenance hemodialysis process significantly affected the levels of activated factor VII, monocyte tissue factor expression, and factor VII antigen with possible role in thrombotic events. Risk evaluation of studied coagulation parameters revealed high odds in CRF patients with elevated VII-rTF, CRF patients showing elevated Monocyte tissue factor expression after dialysis. Also, CRF patients before dialysis with Reduced Protein C activity. Extended coagulation profile study of CRF patients under maintenance hemodialysis should include monocyte tissue factor expression, assay of activated factor VII (VIIa-rTF), factor VII antigen, protein C, protein S, factor V leiden, and lupus anticoagulants.