Objective To investigate the therapeutic significance of early-phase low-dose urokinase for cerebral venous flow obstruction secondary to transsinus acute epidural hematoma (EDH). Methods Clinical data of 166 patients with transsinus acute EDH who admitted in our center between Jan. 2014 and Dec. 2017 was retrospectively analyzed for the clinical efficacy of low-dose urokinase. Results Cerebral venous flow obstruction was jointly diagnosed according to neurological examinations and CT venous / MRV venous images in all the enrolled patients, and dichotomized to Urokinase group (n?=?98, radiographic differential diagnosis was established at early hours after admission) and Ordinary group (n?=?68, radiographic differential diagnosis was carried out until obvious symptom of intracranial hypertension). All the study population received CT venous re-examinations on day 3 to 7 and 10 to 14 after diagnosis. At the time of first reexamination, the involved cerebral sinuses were recanalized in 55 patients, partially improved in 41 patients, stabled in 2 patients in the Urokinase group. By contrast, they were recanalized in 32 patients, partially improved in 4 patients, stabled in 32 patients in the Ordinary group (P?< 0.05). At the time of second reexamination, all the patients in the Urokinase group received a satisfactory clinical and radiographic recovery, and the involved cerebral sinuses were recanalized in 85 patients, partially improved in 12 patients, collaterally compensated in 1 patient. By contrast, the involved cerebral sinuses were recanalized in 47 patients, partially improved in 3 patients, collaterally compensated in 4 patients in the Ordinary group (P?