OBJECTIVES: Anticoagulation therapy with vitamin K antagonists (VKAs) is a common strategy for stroke prevention in patients with non-valvular atrial fibrillation (NVAF) but necessitates regular monitoring of prothrombin time via international normalized ratio (INR) testing. Healthcare systems across the globe have varying ways of managing this. This study explores the economic burden of VKA therapy from a collective perspective for Russian patients with NVAF. METHODS: Consulting patients with NVAF were recruited by cardiologists on a consecutive basis. Patients had to be treated with a VKA for 12-24 months. Cardiologists completed patient record forms, providing clinical characteristics and healthcare resource use data relating to the patient’s first year of treatment. These data were used to quantify direct medical costs (INR testing, consultations, drug costs). The same patients were invited to complete a patient questionnaire providing data on direct non-medical costs (travel/other expenses for attendance at VKA associated appointments) and indirect costs (opportunity cost and reduced work productivity). Physician and patient reported data were used to calculate costs per patient per year (US dollars). RESULTS:  Russian cardiologists (n=50) provided data on 400 patients (mean age 63, 47% female) and 351 patients (88%) completed the patient questionnaire. Patients had a mean of 9 INR tests in the first year and estimated direct medical costs totaled $151.1. Only 18.5% of direct medical costs ($28.0) were attributable to drug costs. Estimated annual direct non-medical costs were $22.9 per patient due to transport fees, meals and other expenses associated with appointment attendance. Annual indirect costs were $275.6 per patient. Loss of work/ leisure time contributed to this and 10 patients reported being unemployed due to VKA treatment. CONCLUSIONS: Although VKA drugs costs are relatively low, this treatment involves regular INR testing and cardiologist consultations which drive the economic burden for Russian NVAF patients treated with VKA.