Objective To assess the efficacy and safety of low-dose urokinase plus conventional treatment versus conventional treatment alone in patients with unstable angina. Methods We searched the database PubMed, EMBASE, The Cochrane Library, SCI, CBM, CNK, VIP and Wanfang database on line by computer, and handsearched relevant professional journals by two independent screening and extract information. The quality of the included documents was evaluated by the criterion of Cochrane handbook 4.2.6. The cochrane collaboration’s Revman 4.2.10 software was used for data analyses. Results A total of 19 randomized controlled trials were included (2 273 patients) Meta-analyses showed that the low-dose urokinase group was better than the conventional treatment group in efficiency [OR= 4.18, 95%CI (3.24, 5.41)] and ECG [OR= 2.81, 95%CI (2.04, 3.88)], and there were no differences between the two groups in cardiovascular outcomes [OR= 0.74, 95%CI (0.44,1.24)], mucocutaneous bleeding [OR= 1.43, 95%CI (0.90, 2.28)], gums bleeding [OR= 1.88, 95%Cl (0.46, 7.70)] and microscopic hematuria [OR= 3.82, 95%CI (0.77, 18.92)]. Conclusion The low dose urokinase group is higher efficient than the conventional treatment group. As the samples of the included studies are small and their quality is low, more randomized, double-blind, high-quality and big- sample trials are required.