Warfarin has ruled the roost for decades as the oral drug of choice for preventing venous thromboembolism. Now, there’s a new kid on the block and it has a chance to get real big.

Last week, an FDA advisory panel voted 15-2 to recommend that the agency approve rivaroxaban for short-term prophylaxis against VTE in patients that have undergone hip or knee replacement surgery.

Typically, the FDA follows the recommendations of its advisory panels.

Rivaroxaban is the result of a JV involving Bayer and Johnson & Johnson.

Industry experts believe that rivaroxaban could generate $200 million in sales for the orthopedic use, but the real prize lies with a large population of patients who take warfarin chronically for stroke prevention and sundry cardiac indications.

“This is Act 1 of a multiact play,” Rick Wise, a Leerink Swann analyst told the New York Times.

UBS Securities analyst Bruce Nudell estimated for example that rivaroxaban could generate $6 billion in annual revenue by completely supplanting the generically-available warfarn, unlikely though that may be.

Physicians and patients alike have chafed for decades at the nuisance factor associated with taking warfarin. The drug requires frequent blood tests to assure proper dosing and has this annoying tendency to cause bleeding and death.

Problem is, the new kid might not be much better in this regard. Trials comparing it with enoxaparin, an injectible anticoagulant, showed it to be better at reducing blood clots but saddled with nearly twice the incidence of major bleeding events.

That’s why panelist Sanjay Kaul voted against approving the new kid. “I saw a risk-benefit ratio which was a washout,” the Cedars Sinai cardiologist told the Times.

Seattle Semi-Pro Wrestling has entertained bar patrons in the Pacific Northwest for 6 years with its lampoons of World Wrestling Entertainment.

The cast includes Ronald McFondle, a raunchy rendition of a the iconic hamburger peddler who finishes off opponents with a lewd gesture and a vainglorious fellow named Deevious Silvertongue who looks like a cross between David Bowie and Liberace.

The characters grapple on foam padded stages, or at least they did until the Washington State  Department of Licensing classified the show as “sports entertainment,” meaning the SSP had to post a $10,000 bond, hire medical personnel to monitor events, and buy a regulation wrestling ring.

The SSP, which has no money to speak of, plans to appeal the ruling but has halted matches in the meantime.

“It’s a bunch of grown men and women in costumes pretending to be professional wrestlers,” David Osgood, the league’s lawyer told the Wall Street Journal. “It is to wrestling as ‘West Side Story’ is to actual gang relations.”

To which department spokesperson Christine Anthony countered that pro wrestling “is just as much theater as these guys claim to be.” The department considers the WWE to be sports entertainment and requires it to have a license to perform in the state.

The smackdown was prompted by a fallout involving the league and The Banana, one of its characters. Apparently, Paul Richards, who played The Banana, left the league upon hearing of plans to sideline his character.

The league had named Lucas Keyes to be The Second Banana, a sidekick to The Banana, and planned to have The Second Banana betray and then defeat The Banana.

Richards stormed off rather than lose his status as the top banana, according to the Journal.

That might have been the end of it, but then Richards found out that SSP members were ridiculing him behind his back, so he notified the licensing department that he believed SSP was violating the law.

In his appeal, Osgood will argue the ruling threatens everything from jello wrestlers to actors engaging in a sword fight in “Hamlet.”

“We’re in ‘Looney Tunes’ territory here,” he told the Journal.