OBJECTIVES: To compare the all-cause medical resource utilization in chronic liver disease (CLD) patients with thrombocytopenia (TCP) versus no thrombocytopenia, using the Veterans health administration (VHA) database. METHODS: All utilization records of patients in the VA national patient care databases, who had a diagnosis of CLD between 1999 and 2008,  were followed from the date of CLD diagnosis to 180 days following the earlier of two events: the last date a platelet count was available for each patient, or the date of the last platelet count of fewer than 50,000 cells  / μL. Platelet counts and outcomes such as, number of physician visits (PV) and outpatient procedures (OPP), and healthcare costs (HCC) were determined for every three month period up to study end for each eligible patient, using a longitudinal per patient per 3-month dataset. Generalized linear models (GLMs) were used to study the impact of change in platelet counts on health care utilization and costs, after adjusting for hepatitis C infection  and other covariates. RESULTS: A total of 935 and 256,516 patient-3-month observations were available for comparing health care use in CLD patients with TCP versus no TCP respectively. After adjusting for liver disease severity and other covariates incidence rate ratios for PV and OPP for an increase in platelet counts by 25,000,  were 0.992 (95% CI: 0.990-0.993, p <0.0001) and 0.989 (95% CI: 0.987 – 0.990, p <0.0001) respectively. For a decrease in platelet counts of 10,000 and 25,000 among observations with a maximum platelet count of 50,000 / μL during the study period, the average predicted change in overall health care costs per quarter was +$139 (SD: $379) and +$369 (SD: $1,004), respectively (p <0.0001).   CONCLUSIONS: In a VA patient population with CLD, TCP is associated with modest increase in health care utilization and costs as compared to no TCP.