In 1987 antistasin was tested as the first direct Xa inhibitor. Antistasin is a protein made up of 119 amino acid residues, of which 20 are cysteines involved in 10 disulfide bonds. It acts as a slow, tight-binding inhibitor of factor Xa with a Ki value of 0.3–0.6 nM but it also inhibits trypsin. Recombinant Antistasin can be produced by genetically modified yeast, saccharomyces cerevisiae. Another natural occurring direct Xa-inhibitor, the tick anticoagulant peptide (TAP), was discovered in 1990. It is a single-chain, 60 amino acid peptide and like antistasin it is a slow, tight-binding inhibitor with a similar Ki value (~0.6 nM).
These two proteins were mostly used to validate factor Xa as a drug target. Animal studies suggested direct Xa-inhibition to be a more efficient approach to anticoagulation compared to direct thrombin inhibitors, especially offering a wider therapeutic window and reducing the risk of rebound thrombosis, (increase in thromboembolic events occurring shortly after the withdrawal of an antithrombotic medication) compared to direct and indirect thrombin inhibitors.
During the 1990s several low-molecular-weight substances were developed, such as DX-9065a and YM-60828.
DX-9065a was the first synthetic compound that inhibited FXa without inhibiting thrombin. That was attained by inserting a carboxyl group which seemed to be the most important moiety for a selective binding to FXa. Those early developed small molecules yet had amidine-groups or even higher-basic functions, which were thought to be necessary as mimics for an arginine residue in prothrombin, the natural substrate of factor Xa. Nevertheless, these basic functions are also related to a very poor oral bioavailability (e.g. 2–3% for DX-9065a).
In 1998 Bayer Healthcare, a pharmaceutical company started searching for low-molecular-weight direct factor Xa inhibitors with higher oral bioavailability. High-throughput screening and further optimisation at first lead to several substances from the class of isoindolinones demonstrating that much less basic substances can also act as potent Xa inhibitors to an IC value of up to 2 nM. Although isoindolinones have a better oral bioavailability than the original compounds it wasn't sufficient enough. However, the project later lead to the class of n-aryloxazolidinones that provides substances with both high potency of inhibiting factor Xa and high bioavailability. One compound of this class, Rivaroxaban (IC = 0.7 nM, bioavailability: 60%), was granted marketing authorization for the prevention of venous thromboembolism in Europe and Canada in September 2008.