The perils of inhibiting deficient factors.

Essentials Anticoagulation in patients with factor X deficiency is an evidence-poor area. A patient with factor X deficiency was anticoagulated with warfarin followed by rivaroxaban. Warfarin may be a safer anticoagulant option than rivaroxaban in hereditary factor X deficiency. A baseline coagulation screen should be performed prior to commencement of anticoagulation. SUMMARY: We report a case of a previously undiagnosed factor X deficiency in an 83-year-old man who had no previous bleeding history despite multiple hemostatic challenges. He was anticoagulated with warfarin for atrial fibrillation without bleeding complications; however, major hemorrhage occurred soon after a switch to rivaroxaban.

Hospital-based physicians and possible problems under the IRS affiliated service group rules.

Recent publicity surrounding the possible application of Internal Revenue Code Section 414(m)(5) to hospital-based physicians, and the effect such application would have on employee benefit programs they sponsor, has created confusion and uncertainty for these physicians and their advisers. This article explains the affiliated service group rules and the contrasts between the rules as set forth in the Internal Revenue Code and the proposed regulations interpreting those rules.