OBJECTIVES: Acute coronary syndrome is a "vehicle diagnosis", the ambulance service and involves unstable angina, myocardial infarction, including – without segment elevation of ST segment. Aim of this study was to conduct clinical and economic analysis of application of fondaparinux sodium and enoxaparin sodium in the treatment of acute coronary syndrome.  METHODS: The method of modeling with decision-tree model and "cost-effectiveness" ratio were used. Endpoints were: mortality, the onset of myocardial infarction in the 9th, 30th and 180th day from the start of the study regarding  the side effects in patients with acute coronary syndrome based on the results of clinical trials OASIS-5. Calculating the cost of drugs and medical services was conducted according to experts and standard of medical care.  RESULTS: The cost of treatment of a single patient with acute coronary syndrome with fondaparinux sodium were lower compared with enoxaparin sodium to 9th, 30th and 180th day of treatment at 38 €, 42 € and 36  €, respectively. The cost-effectiveness ratio on the criterion of "the likelihood of myocardial infarction" for fondaparinux and enoxaparin on the 9^th day of treatment was 5210 € and 6641 €, on the 30^th day - 4084 € and 4810 €, on the 180^th day - 3396 € and 3939 €, respectively. The cost-effectiveness ratio on the criterion "probability of death" for fondaparinux and enoxaparin on the 9^th day of treatment was 7525 € and 9088 €, on the 30^th day - 5351 € and 5635 €, on the 180^th day - 3839 € and 4171 €, respectively.  CONCLUSIONS: The use of fondaparinux sodium is the dominant technology in myocardial infarction without lifting ST segment, other direct anticoagulants are assigned only in case of its absence.