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.