Rivaroxaban is an oral anticoagulant licensed for the treatment of acute deep vein thrombosis (DVT), and prevention of recurrent DVT and pulmonary embolism (PE) following an acute DVT in adults. It is also licensed for the prevention of stroke and systemic embolism in adult patients with additional risk factors with non-valvular atrial fibrillation. In addition, rivaroxaban has been licensed in the UK for the prevention of venous thromboembolism (VTE) in adult patients undergoing hip or knee replacement surgery. The National Institute for Health and Excellence (NICE) has approved rivaroxaban as a treatment option for all its licensed indications ( NICE 2012a , b , c ). Rivaroxaban is a highly selective direct factor Xa inhibitor with oral bioavailability. Inhibition of factor Xa interrupts the intrinsic and extrinsic pathway of the blood coagulation cascade, inhibiting both thrombin formation and development of thrombi. Rivaroxaban does not inhibit thrombin (activated Factor II) and has effects on platelets have been demonstrated (Bayer, 2012). Rivaroxaban is administered as a fixed dose regimen, and unlike vitamin K antagonists such as warfarin it does not require regular laboratory monitoring and has no known food, with few drug interactions.