It was analyzed the efficiency and safeness of disaggregant therapy before CABG in patients with high risk of acute coronary complications. 321 patients with coronary artery disease were included in a prospective study and divided into two groups: Group 1 with a high risk, n=103 (angina FC III-IV; stenosis 50% of the proximal/middle LMCA, three-vessel coronary artery disease with stenosis 70%, ACS/acute cerebrovascular accident, PCI with stenting or without it in the previous 12 months) with the continuation of acetylsalicylic acid therapy (125 mg/day); and Group 2 with 218 patients who received heparin in dose of 20,000 U/day after the withdrawal of disaggregant therapy. The standard laboratory values of hemostasis and clinical data were measured: rate of postoperative bleeding, qualitative and quantitative characteristics of transfusion therapy, the need for resternotomy, perioperative myocardial infarction, arrhythmias, gastrointestinal bleeding, the need for renal replacement therapy, pulmonary complications, deaths. Intraoperative blood loss was comparable in both groups. The number of perioperative complications was comparable, but there were no cases of myocardial infarction before surgery in the group on disaggregant therapy. The continuation of preoperative disaggregant therapy in high-risk patients required changes in the quality of transfusion therapy, did not result in an increase of blood loss and perioperative complications, ensured the absence of acute myocardial infarction in the perioperative period. All mentioned above suggests the expansion of indications for the preoperative continuation of disaggregant therapy in coronary artery bypass grafting surgery.