Taking three blood thinner medications at once can be a necessary treatment for some patients, but including Xarelto in that mix can cause the risk of severe bleeding to skyrocket, attorneys suing two major drug companies on behalf of a man who suffered a near fatal bleed told a Philadelphia jury Friday.

The arguments came during opening statements in Russell v. Janssen Pharmaceuticals, which is the second Xarelto case to be tried in Philadelphia state court. The case focuses on plaintiff Daniel Russell, who suffered a bleed in 2011 while he was taking Xarelto along with Aspirin and Plavix, which is often called dual antiplatelet therapy.

According to Levin Papantonio Thomas Mitchell Rafferty & Proctor attorney Brian Barr, who made most of the plaintiff's opening statement to the jury, the drug companies knew that taking Xarelto along with a dual antiplatelet therapy significantly increased the risk of a severe bleed, but they did not disclose that to the medical community for fear it would hurt sales of the drug.

“Why did they stay silent? Why did they make a conscious decision to stay silent? Because they wanted to be able to sell Xarelto to people like Dan,” Barr said. “All of this pressure made Bayer and Janssen forget that their ultimate responsibility is to protect the patient.”

Russell's case represents the first chance for plaintiffs to argue that defendants Janssen and Bayer failed to adequately warn about the dangers of taking Xarelto when patients are also treating with a dual antiplatelet therapy. According to plaintiffs' liaison counsel, Michael Weinkowitz of Levin Sedran & Berman, about 25 percent of the more than 1,500 Xarelto cases pending in Philadelphia's mass tort program involve plaintiffs who took Xarelto in conjunction with Aspirin and Plavix.

Russell, a New Jersey resident, had been treating with dual antiplatelet therapy because he suffered acute coronary syndrome, which had previously required him to have a stent installed. In 2013, he was prescribed Xarelto to address a separate condition stemming from an irregular heartbeat, known as atrial fibrillation, which can often lead to stroke.

Barr told the jury that triple therapy, which is using an anticoagulant like Xarelto in addition to dual antiplatelet therapy, is relatively common in the United States with about 600,000 being treated this way. Finding that Xarelto created a severe bleeding risk “should have been shouted from the rooftops,” Barr said.

“They should have immediately put it in the label,” Barr said.

Attorney Brian Stekloff of Washington, D.C.-based Wilkinson Walsh + Eskovitz, who made most of the opening statement for the defendants, countered that the treating doctors were well aware that taking an anticoagulant in addition to two anti-platelet drugs would increase the chance of bleeding. However, even though doctors knew of the risks, patients suffering from both atrial fibrillation and acute coronary syndrome are at a high risk for developing strokes that are often more dangerous than gastrointestinal bleeds, which Russell suffered about a week after he started taking Xarelto.

“The doctors said Russell's risk of stroke was greater than his risk of a bleed,” Stekloff said. ”Both doctors stand by their decision, because nothing would have changed their decision.”

The Russell case is being tried several months after another Philadelphia jury awarded nearly $28 million to a woman who suffered a severe bleed while taking Xarelto along with Aspirin. That award, however, was later reversed by Philadelphia Court of Common Pleas Judge Michael Erdos, who is also presiding over Russell.

Three other Xarelto cases have been tried in federal court. Those cases all resulted in defense verdicts. Barr was co-lead counsel in the federal cases.