Arterial thrombosis in acute coronary syndrome (ACS) is associated with activation of platelets and the coagulation cascade. Persistent thrombin levels have been reported after ACS in such patients. Novel oral anticoagulants without a need of close monitoring and frequent blood tests such as warfarin can provide a chronic beneficial effect on recurrent ischaemic events in such a population. Rivaroxaban, a new oral factor Xa inhibitor, has been tried for this indication in the ‘Anti-Xa Therapy to Lower Cardiovascular Events in Addition to Standard Therapy in Subjects With Acute Coronary Syndrome ACS 2-Thrombolysis In Myocardial Infarction 51’ (ATLAS ACS 2-TIMI 51) trial using a low dose regimen in an attempt to balance the adverse effects of bleeding related to chronic anticoagulation on background of dual antiplatelet therapy for ACS, and the beneficial effects on recurrent coronary ischemia. The role of rivaroxaban in this context has been discussed in detail in this review.