During closing arguments in the latest trial over the safety of Xarelto, Wilkinson Walsh + Eskovitz attorney Brian Stekloff, who argued for the defendant drugmakers, did not dispute that the blood thinner can cause severe and sometimes fatal bleeding, especially when combined with other anticoagulant medications.

But even acknowledging those risks, he stressed the treatment is necessary for patients with very complicated medical problems that are difficult to manage in closing arguments to a Philadelphia jury Tuesday.

Stekloff, who is based in Washington, D.C., made the argument after noting that plaintiff Daniel Russell, who is suing Janssen Pharmaceutical and Bayer after suffering a severe bleed, suffered from numerous cardiovascular conditions, including coronary artery disease and mitral regurgitation, in addition to the atrial fibrillation, for which he was prescribed Xarelto.

“It shows that he was a difficult patient to manage. His history of medical conditions put his heart in a bad place,” Stekloff said.

Stekloff further told the jury that these risks were well known to the medical community, and that Russell's treating physicians decided that the benefits of the drug outweighed the risks, given the medical complications he was facing.

“The label says it can cause serious or fatal bleeding,” Stekloff told the jury. “There is no greater warning that you can have.”

Counsel for the plaintiffs, however, painted a very different picture earlier in the day.

According to Levin Papantonio Thomas Mitchell Rafferty & Proctor attorney Brian Barr, who represented Russell, if Janssen was the Cleveland Cavaliers, then its blockbuster medication Xarelto was the company's LeBron James.

Barr made the analogy in an attempt to show that the company would take great strides to protect its star player, including allegedly failing to adequately warn doctors and the medical community about the risks of the blockbuster blood thinner.

“The team fails without him,” Barr told the jury. “The marketing department needed to protect the franchise.”

The case, Russell v. Janssen Pharmaceuticals, focuses on Russell, who suffered a bleed in 2011 while he was taking Xarelto along with Aspirin and Plavix, which is often called dual antiplatelet therapy.

Russell is the second Xarelto case to be tried in Philadelphia state court, and the first to focus on the defendants' alleged failure to warn about the dangers of taking Xarelto when patients are also treating with a dual antiplatelet therapy. 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.

The first Xarelto case to come before a Philadelphia jury ended with a $28 million verdict that was later reversed by the trial judge. Three other cases were tried in federal court last year, all of which ended in defense wins. The Russell case, according to plaintiff's counsel, was chosen by the defendants for trial.

During the plaintiff's 75-minute presentation, Barr, who is based in Pensacola, Florida, cited testimony from a marketing executive, saying several of the company's top sellers were about to go generic, and that Xarelto was expected to provide 10 percent of the revenue for Janssen's parent company, Johnson & Johnson. The drug, Barr said, was going to give Janssen the stability it needed, and hundreds of millions of dollars went into marketing the drug to ensure its success.

Those pressures, Barr said, led the company to focus on profits over patients.

“They got tunnel vision,” he said. “They focused purely on profits.”

Closing arguments came after more than two weeks of trial.