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Xarelto EOD Media Report
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Johnson & Johnson, Bayer win second trial over Xarelto bleeding risks
Jun 14, 2017 | Louisiana Record
By Glenn Minnis
A federal jury in New Orleans has cleared Johnson & Johnson and Bayer AG in the second of at least 18,600 suits filed against the pharmaceutical giants stemming from the manufacturing of the blood-thinning drug Xarelto. -
Louisiana federal court jury again finds for defense in second Xarelto bellwether trial
Jun 14, 2017 | PennRecord
By Nicholas Malfitano
The manufacturers of Xarelto are not liable for the death of a Louisiana woman who was prescribed the blood-thinner drug and later died from complications resulting from a brain hemorrhage, a federal court jury has decided. -
Johnson & Johnson, Bayer score a second key win in Xarelto bleeding litigation
Jun 13, 2017 | FiercePharma
By Eric Sagonowsky
Johnson & Johnson and Bayer are two-for-two in defending Xarelto against liability lawsuits. The drugmakers aren’t in the clear yet, though, with another bellwether trial set for August and thousands of additional suits claim the blockbuster blood thinner caused a patient’s injury or death. -
LONDON BRIEFING: Market Attention Shifts To UK Inflation And US Fed
Jun 13, 2017 | Alliance News
Brief mention of the verdict in the Alliance News London Briefing. Relevant portion included below. -
Bayer, J&J win second U.S. trial over Xarelto bleeding risks
Jun 12, 2017 | Reuters
By Nate Raymond
A federal jury has cleared Bayer AG and Johnson & Johnson of liability in the second trial to stem from thousands of lawsuits blaming injuries on the blood thinner Xarelto, the drug companies said on Monday. -
J&J, Bayer Win Second Trial Over Blood-Thinning Drug Risks
Jun 12, 2017 | Bloomberg
By Margaret Cronin Fisk and Della Hasselle
Johnson & Johnson and Bayer AG aren’t responsible for the death of a 67-year-old woman whose family blamed the blood-thinning drug Xarelto, a New Orleans jury found. -
Louisiana Federal Jury Hands Up Defense Verdict in Xarelto Trial
Jun 12, 2017 | National Law Journal
By Amanda Bronstad
On Monday, a jury came out with a defense verdict in the second trial over the blood thinner. That's about a month after Johnson & Johnson and Bayer won the first bellwether trial over Xarelto. -
Bayer, Janssen Win 2nd Xarelto Bellwether Trial
Jun 12, 2017 | Law360
By Cara Salvatore
A New Orleans federal jury on Monday awarded a defense verdict to Janssen and Bayer in the second bellwether trial in multidistrict litigation over unstoppable bleeding allegedly caused by their blood thinner Xarelto.
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Johnson & Johnson, Bayer win second trial over Xarelto bleeding risks
Jun 14, 2017 | Louisiana Record
By Glenn Minnis
A federal jury in New Orleans has cleared Johnson & Johnson and Bayer AG in the second of at least 18,600 suits filed against the pharmaceutical giants stemming from the manufacturing of the blood-thinning drug Xarelto.
On June 12, the jury found in favor of the plaintiffs in connection with a suit filed on behalf of the family of Sharyn Orr, who perished in 2015 of a stroke that her attorneys argued was made worse because her doctor had not been properly informed about bleeding risks associated with the drug.
The case is the second in a series of bellwether trials related to the drug. The drug makers were also cleared of charges in a related case decided earlier this year.
“We offer our deepest sympathy to the Orr family for their loss,” J&J's Janssen Pharmaceuticals Inc. said in a statement made available to the Louisiana Record. “At Janssen, nothing is more important to us than the health and safety of the patients who use our medicines. The jury’s decision reflects the facts of this case and the appropriateness of Xarelto’s (rivaroxaban) FDA-approved labeling. We will continue to defend against the allegations in this litigation.”
As co-counsels, Andy Birchfield and Brian Barr represent many of the plaintiffs in the ongoing litigation. After the latest verdict, the two indicated they planned to press forward on behalf of their remaining clients.
Xarelto was approved by the U.S. Food and Drug Administration in 2011 and is widely prescribed for people with heart problems such as atrial fibrillation. The drug is also used to treat and reduce the risk of deep vein thrombosis and pulmonary embolisms.
In recent years, plaintiffs have argued that the drug poses several dangers and neither Johnson & Johnson nor Bayer officials have adequately made the public aware of the potential side-effects of uncontrollable and irreversible bleeding linked to its use.
During trial, Joseph Orr and his children insisted that Sharyn Orr suffered her fatal stroke around a year after her doctor prescribed the drug to her for treatment of a heart rhythm disorder. They said that because her doctor had not been properly advised about the drug, he waited at least 12 hours before operating on her because he feared the medication would cause her to bleed.
Johnson & Johnson and Bayer officials maintained warnings about the drug were more than adequate and that it did not trigger her death.
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Louisiana federal court jury again finds for defense in second Xarelto bellwether trial
Jun 14, 2017 | PennRecord
By Nicholas Malfitano
The manufacturers of Xarelto are not liable for the death of a Louisiana woman who was prescribed the blood-thinner drug and later died from complications resulting from a brain hemorrhage, a federal court jury has decided.
Per a jury verdict reached Monday from the U.S. District Court for the Eastern District of Louisiana, Bayer and Janssen Pharmaceuticals, a subsidiary of Johnson & Johnson, were not responsible for the 2015 death of 67 year-old Sharyn Orr, of Kenner, La.
In back-to-back federal bellwether trials, juries have cleared the manufacturers of Xarelto of liability relating to claims that the drug caused internal bleeding, which plaintiff attorneys allege led to severe injuries or deaths in patients who used it.
The Food & Drug Administration (FDA) approved Xarelto in 2011 for prescription to patients suffering from a rhythmic heart disorder called atrial fibrillation and to prevent blood clots which can lead to heart attacks, strokes and pulmonary embolisms.
However, plaintiffs and their counsel charge Xarelto’s manufacturers with failing to properly warn patients that Xarelto use presented increased risks for cranial and gastrointestinal bleeding when taken once daily and not properly monitored.
Orr, an academic advisor at Tulane University, passed away in May 2015, just days after suffering a massive brain hemorrhage and subsequent to an attempt at life-saving surgery. She was prescribed Xarelto in February 2014 to treat her atrial fibrillation, and suffered the brain hemorrhage in April of the following year.
Attorneys for the plaintiffs, Orr’s widower Joseph Orr Jr. and surviving children, Joseph Orr III, Kelli Orr Walker and Kim Orr Deagano, claimed a 12-hour delay waiting for Xarelto to leave the decedent’s system, in order for doctors to safely perform emergency surgery without severe bleeding risk, led to her death.
Plaintiff counsel asserted a Prothrombin Time (PT) test, used to assess a patient for bleeding risks, would have informed doctors when it was safe to operate, but that Bayer and Janssen did not tell doctors the test worked for that purpose.
However, counsel for Xarelto’s manufacturers countered that the PT test isn’t scientifically reliable in their view and that Orr’s death was caused by other factors, such as the irreversible nature of her cranial bleeding.
Andy Birchfield of Beasley Allen in Montgomery, Ala. and Brian Barr of Levin Papantonio of Pensacola, Fla., served as co-lead counsel in the first federal bellwether case decided in May for Xarelto’s manufacturers, Boudreaux v. Janssen Pharmaceuticals, in addition to the instant action brought by the Orr family.
A mutual statement from the plaintiff lawyers in the wake of the second straight jury verdict for the defense indicated they remain undeterred, and will continue to pursue Xarelto litigation claims in future trials.
“On behalf of the Orr family, we want to thank the jury members for their service. We will continue to press forward with the legal claims of the thousands of innocent victims of this drug. The makers of Xarelto owe it to physicians and patients to be transparent about the risks posed by this drug. Physicians outside the U.S. knew as early as 2013 that patient monitoring and a simple blood test would be useful in predicting and identifying patients that are most likely to suffer serious bleeding. But, American doctors were told otherwise – an omission that could have saved our client’s life. The next trial – in August – has its own distinctive set of claims and circumstances, and we look forward to having a jury hear that evidence,” Birchfield and Barr said.
Janssen spokesperson Sarah Freeman also issued a response to the verdict.
“We offer our deepest sympathy to the Orr family for their loss. At Janssen, nothing is more important to us than the health and safety of the patients who use our medicines. The jury’s decision reflects the facts of this case and the appropriateness of Xarelto’s (rivaroxaban) FDA-approved labeling. Xarelto is an innovative medicine used to treat and reduce the risk of life-threatening blood clots. This is the second Xarelto trial and the second verdict in favor of the company. We will continue to defend against the allegations in this litigation,” Freeman said.
Bayer representative Christopher Loder provided further comment on the verdict.
“The defense verdicts in the first two trials affirm both the safety and efficacy of Xarelto, and that its FDA-approved label contains accurate, science-based information on the benefits and risks of this life-saving medicine. Significantly, the jury in the Orr case heard several different theories regarding the alleged inadequacy of the Xarelto label, and did not find there was sufficient evidence to support any of them,” Loder said.
“The health and safety of our patients is Bayer’s top priority. With more than five years on the U.S. market and 28 million patients prescribed worldwide in over 130 countries, real-world experience continues to confirm the favorable benefit-risk profile of Xarelto for patients who have a high risk of life-threatening blood clots that may cause strokes and other serious medical complications. Bayer stands behind the safety and efficacy of Xarelto and will continue to vigorously defend it.”
The group of more than 18,000 Xarelto lawsuits have been consolidated through the federal court system’s multi-district litigation (MDL) process, which utilizes bellwether trials to establish evidence and determine any settlement value for similar plaintiff claims.
The federal Xarelto MDL is listed as Case No. 2592, consolidating individual actions filed against Bayer, Janssen and Johnson & Johnson. Judge Eldon E. Fallon of the U.S. District Court for the Eastern District of Louisiana presided over the instant matter.
Two more bellwether trials are scheduled in federal courts in Mississippi (Aug. 7) and Texas (January 2018), respectively.
More than 1,430 lawsuits – most from out-of-state plaintiffs – will be handled eventually in Philadelphia’s Complex Litigation Center. The CLC has several mass tort programs, including cases over asbestos and Risperdal, and the percentage of claims belonging to out-of-state plaintiffs has traditionally been in the high 80s.
However, in 2016, the percentage for pharmaceutical lawsuits dropped to 74 percent.
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Johnson & Johnson, Bayer score a second key win in Xarelto bleeding litigation
Jun 13, 2017 | FiercePharma
By Eric Sagonowsky
Johnson & Johnson and Bayer are two-for-two in defending Xarelto against liability lawsuits. The drugmakers aren’t in the clear yet, though, with another bellwether trial set for August and thousands of additional suits claim the blockbuster blood thinner caused a patient’s injury or death.
In the case of Joseph Orr, Jr., et al. v. Janssen et al., a federal jury ruled Monday in favor of J&J and Bayer over allegations they withheld info for Xarelto’s official FDA label.
Plaintiffs in the case are the widower and children of Sharyn M. Orr, a grandmother who died in May 2015 at the age of 67 after suffering a brain hemorrhage. Their attorneys said Orr’s death was “completely avoidable,” alleging that the drugmakers concealed safety information that may have saved her life.
On Monday, Sarah Freeman, a spokesperson for J&J, said the company offers its “deepest sympathy to the Orr family for their loss.” She added that the “decision reflects the facts of this case and the appropriateness” of Xarelto’s label.
Andy Birchfield and Brian Barr, co-lead counsel for the plaintiffs, see things differently. The attorneys said their team “will continue to press forward with the legal claims of the thousands of innocent victims of this drug.”
Patient monitoring and a “simple blood test” can help identify patients most likely to suffer severe bleeding, according to the attorneys, who said J&J and Bayer concealed that info from U.S. doctors.
Monday's verdict marks the second bellwether win for J&J’s Janssen unit and Bayer out of about 18,400 cases over Xarelto bleeding injuries, according to a recent J&J filing. The companies came up victorious last month in a separate New Orleans bellwether trial. With thousands of cases pending, early trials can outline the strengths and weaknesses for both sides and potentially lead to a settlement.
First approved by the FDA in 2011, Xarelto was Bayer’s top-selling drug last year at $3.24 billion, and ranked third for J&J at $2.5 billion in sales.
Responding to the jury’s decision on Monday, Bayer in a statement said the “defense verdicts in the first two trials affirm both the safety and efficacy of Xarelto, and that its FDA-approved label contains accurate, science-based information on the benefits and risks of this life-saving medicine.”
The jury “heard several different theories regarding the alleged inadequacy of the Xarelto label, and did not find there was sufficient evidence to support any of them,” according to Bayer’s statement.
The next trial is scheduled for early August in the Southern District of Mississippi.
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LONDON BRIEFING: Market Attention Shifts To UK Inflation And US Fed
Jun 13, 2017 | Alliance News
COMPANIES - INTERNATIONAL
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A New Orleans jury found that Johnson & Johnson and Bayer aren't responsible for the death of a 67-year-old woman whose family blamed the blood-thinning drug Xarelto. The verdict is the second straight win for the companies, which jointly developed the drug. There are still more than 18,000 patient lawsuits over Xarelto, which has been linked to at least 370 deaths. -
Bayer, J&J win second U.S. trial over Xarelto bleeding risks
Jun 12, 2017 | Reuters
By Nate Raymond
A federal jury has cleared Bayer AG and Johnson & Johnson of liability in the second trial to stem from thousands of lawsuits blaming injuries on the blood thinner Xarelto, the drug companies said on Monday.
The verdict by a jury in New Orleans came in a lawsuit by the husband and children of Sharyn Orr, who blamed her 2015 death following a stroke on inadequate information the companies provided her doctor about the drug's bleeding risks.
The case is second in a series of bellwether trials in the federal product liability litigation over Xarelto's bleeding risks. The companies also won in a previous trial on May 3.
The two cases are among an estimated 18,600 lawsuits in federal and state courts related to Xarelto. Bellwethers are supposed to help both sides assess similar claims that the companies downplayed the drug's bleeding risks.
Bayer in a statement said the two verdicts "affirm both the safety and efficacy of Xarelto, and that its FDA-approved label contains accurate, science-based information on the benefits and risks of this life-saving medicine."
J&J's Janssen Pharmaceuticals Inc unit in a statement said it will continue to defend against the allegations in the litigation.
Andy Birchfield and Brian Barr, co-lead counsel for the plaintiffs, in a statement said they "will continue to press forward with the legal claims of the thousands of innocent victims of this drug."
The U.S. Food and Drug Administration approved Xarelto in 2011. The drug is prescribed for people with a common heart rhythm disorder known as atrial fibrillation and to treat and reduce the risk of deep vein thrombosis and pulmonary embolisms.
But plaintiffs contend Xarelto was unreasonably dangerous and that J&J and Bayer, which jointly developed it, failed to warn patients about a serious risk of uncontrollable, irreversible bleeding in emergencies.
In the trial over Orr's death, her husband, Joseph Orr, and her surviving children said she suffered a stroke in late April 2015, a year after her doctor prescribed her Xarelto to treat her atrial fibrillation.
The plaintiffs' lawyers said that based on inadequate information from Bayer and J&J, a doctor decided to wait 12 hours before operating because he feared the Xarelto she took would cause Orr to bleed out. She died on May 4, 2015, despite the surgery.
Bayer and J&J contended Xarelto's warnings were adequate and that any purported inadequacy did not cause her death.
The case is In Re Xarelto Products Liability Litigation, U.S. District Court, Eastern District of Louisiana, No. 14-md-2592.
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J&J, Bayer Win Second Trial Over Blood-Thinning Drug Risks
Jun 12, 2017 | Bloomberg
By Margaret Cronin Fisk and Della Hasselle
Johnson & Johnson and Bayer AG aren’t responsible for the death of a 67-year-old woman whose family blamed the blood-thinning drug Xarelto, a New Orleans jury found.
The verdict is the second straight win for the companies, which jointly developed the drug. There are still more than 18,000 patient lawsuits over Xarelto, which has been linked to at least 370 deaths, according to U.S. Food and Drug Administration reports.
The patients claim Xarelto can cause unstoppable bleeding and that Bayer and J&J failed to provide an antidote or inform doctors or consumers of a blood test that could measure a patient’s bleed-out risk.inRead invented by Teads
Bayer and J&J say Xarelto is safe and bleeding risks are fully outlined in the drug’s warning label. The companies dispute the validity of the blood test, arguing that it doesn’t provide useful information to doctors.
“All medications have risks and benefits, and this one has a huge benefit and it has risks,’’ Beth Wilkinson, the companies’ lawyer, told jurors Monday. “When put in context of all patients who have to take it, the risks are still small.’’Top Seller
Xarelto is Bayer’s top-selling product, generating $3.24 billion (2.9 billion euros) in sales last year and $2.5 billion (2.2 billion euros) in 2015 for the Leverkusen, Germany-based pharmaceutical company. Xarelto is J&J’s third-largest seller, bringing in $2.29 billion in 2016 for the New Brunswick, New Jersey, company.
U.S. regulators approved Xarelto in 2011 to prevent blood clots in users undergoing knee and hip surgeries. The drug’s use was later extended to patients who suffer from irregular heartbeats and are at high risk of stroke.
Sharyn Orr, a Tulane University academic adviser, began taking Xarelto in February 2014 for treatment of atrial fibrillation. Orr died in May 2015, 10 days after suffering a massive brain hemorrhage.
“We are certainly disappointed for the Orr family,” Andy Birchfield, Orr’s lawyer, said after the trial. “We thought the evidence was compelling that they definitely had important safety information shared outside the U.S. that was not shared with doctors in the U.S. We are disappointed in the results but we appreciate the process.”
Xarelto caused the brain bleed and doctors waited until the drug left her system before performing emergency surgery, her family’s lawyers said. That 12-hour delay cost Orr a chance of being saved, they said.Blood Test
A blood test was taken that would have let doctors know that it was safe to operate but the companies hadn’t informed physicians that the test worked for such a use, they said.
Orr underwent emergency surgery to relieve swelling on the brain, but the doctors were unsuccessful, Birchfield said in closing arguments Monday. “The only thing that deprived them of that opportunity early Saturday morning was that she was on Xarelto and the instructions had not told doctors what they needed to know.’’
The companies contend that the Prothrombin Time, or PT, test isn’t scientific. But, Brian Barr, another Orr family attorney, told jurors Monday that Bayer’s label outside the U.S. tells doctors the test “may be useful,’’ to detect bleeding risks in situations such as overdoses, acute bleeding or urgent surgery.
Xarelto didn’t cause the brain bleed, which was set off by her high blood pressure, the companies argued at trial. Orr was taking the medication to prevent stroke, but had other serious disorders beyond hypertension, including poorly managed diabetes and chronic kidney disease, Bayer and J&J said in court papers.
“She was declining internally every year while she was facing those conditions,’’ Wilkinson told the jury Monday. “She was on five different medications for hypertension.’’
A different warning or a quicker surgery wouldn’t have saved her, Bayer and J&J said.
The bleeding was “deep in her brain where they couldn’t remove it,’’ Wilkinson said. When Orr went into the hospital, the doctor saw micro aneurysms in her eyes and knew that the bleeding in the brain was fatal, she said.
The PT test “would not have helped Mrs. Orr.’’ Wilkinson pointed to a recent article in a science publication that said, in part, that “clinicians can no longer rely on normal PT to determine that an anti-coagulated patient is safe to undergo an invasive procedure.’’
“The defense verdicts in the first two trials affirm both the safety and efficacy of Xarelto, and that its FDA-approved label contains accurate, science-based information on the benefits and risks of this life-saving medicine,” Christopher Loder, a Bayer spokesman, said following the verdict. “Bayer stands behind the safety and efficacy of Xarelto and will continue to vigorously defend it.”
J&J will also continue to fight the lawsuits, company spokeswoman Sarah Freeman said.
“The jury’s decision reflects the facts of this case and the appropriateness’’ of Xarelto’s FDA-approved labeling, she said in an email. “Xarelto is an innovative medicine used to treat and reduce the risk of life-threatening blood clots.’’
The next trial begins Aug. 7 in federal court in Jackson, Mississippi.
The case is Orr v. Janssen Research & Development, 15-cv-03708, U.S. District Court, Eastern District of Louisiana (New Orleans).
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Louisiana Federal Jury Hands Up Defense Verdict in Xarelto Trial
Jun 12, 2017 | National Law Journal
By Amanda Bronstad
It's not looking good for the Xarelto plaintiffs' bar.
On Monday, a jury came out with a defense verdict in the second trial over the blood thinner. That's about a month after Johnson & Johnson and Bayer won the first bellwether trial over Xarelto.
Beth Wilkinson of Washington, D.C.'s Wilkinson Walsh + Eskovitz was lead defense counsel in both trials, which took place in New Orleans. This month's trial, which began on May 30, involved a case brought by the husband and children of Sharyn Orr, who died from a hemorrhagic stroke in 2015 after taking Xarelto for one year.
In the first trial, jurors deliberated for less than two hours before rendering their verdict on May 3. This time, the jury deliberated for about three hours.
"The jury's decision reflects the facts of this case and the appropriateness of Xarelto's (rivaroxaban) FDA-approved labeling," said Sarah Freeman, a spokeswoman for Janssen Pharmaceuticals Inc., the Johnson & Johnson subsidiary named in the case, in a statement.
More than 16,000 cases have been filed alleging that Xarelto, an anticoagulant used to treat blood clots and prescribed for atrial fibrillation, has caused uncontrollable internal bleeding in patients. Monday's verdict comes in the second of four bellwether trials scheduled before U.S. District Judge Eldon Fallon of the Eastern District of Louisiana.
In a statement, lead plaintiffs' counsel Brian Barr and Andy Birchfield insisted the third trial would go their way.
"We will continue to press forward with the legal claims of the thousands of innocent victims of this drug," wrote Birchfield, head of the mass torts section of Beasley, Allen, Crow, Methvin, Portis & Miles in Montgomery, Alabama, and Barr, shareholder at Levin Papantonio Thomas Mitchell Rafferty Proctor in Pensacola, Florida. "The next trial — in August — has its own distinctive set of claims and circumstances, and we look forward to having a jury hear that evidence."
Plaintiffs have claimed that Xarelto's manufacturers failed to warn of its problems, though defendants have insisted that the drug comes with a warning about bleeding risks. In a statement, Bayer HealthCare Pharmaceuticals Inc. spokesman Christopher Loder said: "Significantly, the jury in the Orr case heard several different theories regarding the alleged inadequacy of the Xarelto label, and did not find there was sufficient evidence to support any of them."
Wilkinson applauded the speed of the jury's work.
"We are grateful to the jury for their quick verdict and our hearts go out to the Orr family," she said.
The Xarelto litigation has become a lightning rod for tort reform backers like the U.S. Chamber of Commerce's Institute for Legal Reform, for the number of TV ads soliciting for potential plaintiffs. But advertising did not play a role in this month's trial.
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Bayer, Janssen Win 2nd Xarelto Bellwether Trial
Jun 12, 2017 | Law360
By Cara Salvatore
A New Orleans federal jury on Monday awarded a defense verdict to Janssen and Bayer in the second bellwether trial in multidistrict litigation over unstoppable bleeding allegedly caused by their blood thinner Xarelto.
It was the second win for the drug companies in the 15,000-case litigation. The verdict came just hours after the end of closing arguments in New Orleans on Monday.
In the case, widower Joseph Orr said that the companies failed to warn doctors of Xarelto's dangers, and therefore were responsible for the stroke that killed his wife Sharyn Orr in May 2015.
Janssen Pharmaceuticals Inc. in a statement Monday afternoon offered condolences to the Orr family but stood behind “the appropriateness of Xarelto’s ... FDA-approved labeling.” Similarly, Bayer HealthCare Pharmaceuticals Inc. said that Xarelto's “FDA-approved label contains accurate, science-based information.”
Bayer said the Orr family's lawyers offered the jury a variety of reasons to find fault with the drugmakers, and that the jury still declined.
Representatives for the Orr family stressed Monday afternoon that, notwithstanding the label language, U.S. doctors were victims of an informational imbalance.
“Physicians outside the U.S. knew as early as 2013 that patient monitoring and a simple blood test would be useful in predicting and identifying patients that are most likely to suffer serious bleeding. But American doctors were told otherwise,” attorneys for the family said in a statement after the verdict.
Sharyn Orr was an academic adviser at Tulane University and was 67 at the time of her death, according to the plaintiffs.
A third bellwether is set for August.
The Orr family is represented by Andy Birchfield of Beasley Allen Crow Methvin Portis & Miles PC and Brian Barr of Levin Papantonio Thomas Mitchell Rafferty Proctor PA.
The drugmakers are represented by Beth Wilkinson of Wilkinson Walsh & Eskovitz and Susan Sharko of Drinker Biddle & Reath LLP.
The case is In re: Xarelto (Rivaroxaban) Products Liability Litigation, case number 2:14-md-02592, in the U.S. District Court for the Eastern District of Louisiana.
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