A 45-day course of daily subcutaneous injection with the factor Xa inhibitor fondaparinux or with low-molecular-weight heparin is the recommended treatment for patients with superficial-vein thrombosis (SVT). A clinical trial now shows that rivaroxaban, an oral factor Xa inhibitor, is noninferior to fondaparinux for the prevention of thromboembolic complications in these patients. This open-label, randomized, noninferiority trial included 485 patients with SVT at high risk of thromboembolic complications. The primary end point (a composite of symptomatic deep-vein thrombosis or pulmonary embolism, progression or recurrence of SVT, and all-cause mortality at 45 days) occurred in 3% and 2% of patients in the rivaroxaban and fondaparinux groups, respectively (HR 1.9, 95% CI 0.6–6.4, P = 0.0025 for noninferiority), without major bleeding events. Rivaroxaban is cheaper than fondaparinux, and use of an oral anticoagulant might provide a simple and effective alternative to daily subcutaneous injections.