Objective To study the clinical efficacy of rivaroxaban treatment for acute pulmonary embolism and the effect of it on vascular endothelial function. Method A total of 50 patients with acute pulmonary embolism in our hospital during the period from Jan 2015 to Jan 2018 were randomized into the control group (warfarin treament) and the observation group (rivaroxaban treatment) according to random number method, 25 patients per group. The clinical efficacy of treatment, changes of arterial partial pressure of oxygen (PaO2), partial pressure of carbon dioxide (PaCO2), heart rate (HR), and C reactive protein (CRP), cTnI, D-dimer (D-D), endothelin-1 (ET-1), nitric oxide (NO), vascular pseudomonia factor (vWF) in two groups were observed and compared. Results Compared with the control group, the total effective rate of treatment in the observation group was increased (P?< 0.05); Compared with the control group, the levels of PaO2 and PaCO2 were increased and HR was decreased after treatment in the observation group (P?