Rivaroxaban has been studied extensively in various clinical settings, its efficacy and safety at low doses for patients with anterior myocardial infarction (AMI) have not been fully investigated. Aim of the study: Evaluation of the the efficacy and safety of low-dose Rivaroxaban in patients with anterior ST-segment elevation myocardial infarction . Methods: The study involved 150 participants with AMI received primary percutaneous coronary intervention (PCI) within the therapeutic window , randomly divided into two groups. The first group (75 patients), received low dose of Rivaroxaban (2.5 mg twice daily orally after food) for one month , in addition to dual antiplatelet therapy. The second (control) group (75 patients), only received the standard dual antiplatelet therapy .Results: After one month the Rivaroxaban group showed a significant improvement in left ventricular function compared to its baseline. Left ventricular thrombus didn't occur in the Rivaroxaban group; however, there was a 4.2% incidence the control group , though this was not statistically significant. The mortality rate was lower in the Rivaroxaban group (1.3%) compared to the control group (4%), even so this difference was not statistically significant. Stroke was significantly less in the Rivaroxaban group. However, the rates of stent thrombosis and minor bleeding were similar and not statistically significant between groups. No cases of major bleeding were reported in both groups.Conclusions: Low-dose Rivaroxaban, when used in conjunction with standard dual antiplatelet therapy, appears to offer improvement in cardiac function and reduce the risk of stroke without elevating the risk of bleeding or mortality.