Objective To discuss the efficacy and safety of rivaroxaban tablets in acute coronary syndromes. Methods A total of 70 acute coronary syndromes patients were randomly divided into experimental group and control group, with 35 cases in each group. The control group was treated with low molecular heparin, and the experimental group was treated with rivaroxaban tablets. Comparison were made on occurrence of cardiovascular events and complications between two groups. Results The experimental group had incidence of of cardiovascular events as 5.7%, while the control group had incidence of cardiovascular events as 22.9%. The experimental group had lower incidence of cardiovascular events than the control group, and the difference was statistically significant（P〈0.05）. The experimental group had incidence of complications as 2.9%, while the control group had incidence of complications as 17.1%. The experimental group had lower incidence of complications than the control group, and the difference was statistically significant（P〈0.05）. Conclusion Rivaroxaban tablets shows remarkable efficacy in treating acute coronary syndromes with high safety, and is worthy of promotion.