Objective: To investigate the coagulation function in patients with acute-on-chronic liver failure (ACLF) patients using thromboelastography (TEG), and to comprehensively and dynamically evaluate patients’ bleeding and coagulation status. Methods: The clinical data of ACLF patients were collected, and TEG was used to evaluate whole blood clotting kinetics in these patients. Routine biochemical parameters were measured, and complications were evaluated. The t-test was used for comparison of continuous data, the chi-square test was used for comparison of categorical data, and the Pearson correlation coefficient was used for correlation analysis. P < 0.05 was considered statistically significant. Results: A total of 60 patients (39 male and 21 female patients) were enrolled, with a mean age of 47.20±16.20 years. The TEG results showed that all patients had normal thrombokinetics, but TEG parameters were correlated with coagulation function, markers of systemic inflammatory response syndrome, laboratory markers, and prognosis. The patients with a higher R value had higher risks of infection (6.23±2.91 vs 4.74±1.12, P = 0.009), hepatorenal syndrome (5.64±2.54 vs 3.21±1.43 P < 0.01), and bleeding (6.71±3.51 vs 4.80±1.63, P = 0.01), and the patients with a lower K value (0.72±1.36 vs 1.64±1.43, P = 0.02), an increased α-angle (63.33°±10.02° vs 56.62°±12.13°, P = 0.03), and an increased MA (56.83±11.07 vs 50.40±10.81, P = 0.03) had increased risks of hepatic encephalopathy. Conclusion ACLF patients have low coagulation function, and TEG truly reflects the "rebalance" status of this low level. Abnormal TEG parameters suggest increased risk of complications in these patients, indicating a poor prognosis.