OBJECTIVES: As far as combination of aspirin and clopidogrel was recently recommended by Russian National Society of Cardiology as well as AHA “when oral anticoagulation with warfarin is considered unsuitable”, the urgent need to compare its cost-effeciveness with novel oral anticoagulant dabigatran is appear. METHODS: Present study was based on Markov model with 10 years time horizon simulated the cohort of 10 000 AF patients at moderate-to-high stroke risk while tracking clinical events and resulting functional disability. Direct expenses associated with complications and resulting long-term follow-up costs were calculated using general tariff agreement of Russian obligatory insurance system and official national statistics.  RE-LY, Active W trials and published metaanalises were used as main clinical data sources. Clinical events per 100 patient-years, total costs and incremental cost effectiveness ratio (ICER) for both therapy regimens were evaluated. The robustness and stability of the results were tested using sensitivity and PSA analyses. RESULTS: Over a 10 years period patients treated with dabigatran in comparison with those receiving dual antiplatelet therapy experienced fever ischemic strokes (1.8 vs. 3.49), extracranial bleedings (2.53 vs. 2.76) and hemorrhagic strokes (0.41 vs. 0.44) per 100 patient-years. Total cost of medications accounted for 266,089 Roubles in dabigatran group and 249,870 Roubles in dual antiplatelet therapy group, cost of complications treatment – 12,500 Roubles and 18,182 Roubles, cost of follow-up after occurred complications and rehabilitation – 24987 Roubles and 37620 Roubles per 100 patients respectively. In total, absolute cost-saving associated with dabigatran use was 20,948 Roubles per 100 patients. CONCLUSIONS: Dabigatran use in stroke prevention in atrial fibrillation may be considered as cost-saving alternative to aspirin plus clopidogrel combination in patients with warfarin intolerance.