Ximelagatran is a novel oral anticoagulant belonging to a class of drugs known as direct thrombin inhibitors. Numerous recent large-scale, randomised controlled clinical trials have given the drug a large clinical platform. These include data on the thromboprophylaxis of venous thromboembolism following major orthopaedic surgery and knee arthroscopy, as well as in the treatment of deep vein thrombosis and prevention of stroke with nonvalvular atrial fibrillation. One phase II study has also shown the efficacy and safety of ximelagatran in secondary prevention post-myocardial infarction. Unfortunately, approximately 6% of patients develop usually self-limiting derangement of liver dysfunction, and frequent monitoring of liver function is likely to be recommended for the first 6 months of treatment. Unlike the vitamin K antagonists, ximelagatran has a wide therapeutic interval with few food, alcohol or drug interactions, and it does not require anticoagulant monitoring. The aim of this overview is to review the clinical trials pertaining to this new drug, which is the first new oral anticoagulant for over 60 years, and one that is likely to influence our management of thrombosis-related disorders.