OBJECTIVE: To systematically evaluate the efficacy, safety and economy of generic Clopidogrel hydrogen sulphate tablets versus original drug in the treatment of coronary heart disease (CHD), and to provide evidence-based reference for clinical treatment. METHODS: Retrieved from PubMed, Embase, Medline, Cochrane Library, CBM, CJFD, VIP and Wanfang database, randomized controlled trials (RCTs) about the efficacy (platelet aggregation rate, clinical response rate), safety (incidence of main cardiac adverse event, incidence of ADR) and economy of generic Clopidogrel hydrogen sulphate tablets (trial group) versus original drug (control group) in the treatment of CHD were collected from Jan. 2008-Mar. 2018. After quality evaluation and information extraction of clinical studies which met inclusion criteria, RevMan 5.3 statistical software was used for Meta-analysis. RESULTS: Totally 26 RCTs were enrolled, involving 3 058 patients. Results of Meta-analysis showed there were no statistical significance in the change of platelet aggregation rate [WMD=0.58,95%CI(-0.35,1.51),P=0.22], clinical response rate [OR=0.83,95%CI(0.46,1.50),P=0.54], the incidence of main cardiac adverse event [OR=0.97,95%CI(0.63,1.47),P=0.87] or the incidence of ADR [OR=1.15,95%CI(0.78,1.70),P=0.49] between 2 groups. The cost-effectiveness ratio of trial group had obvious advantages, compared with control group (cost-effectiveness ratio of generic drug A and B with original drug for clinical efficacy were 3 014.70, 2 417.41, 5 692.98; cost-effectiveness ratio of main cardiac adverse events were 3 006.21, 2 410.66, 5 760.24). CONCLUSIONS: Therapeutic efficacy and safety of generic Clopidogrel hydrogen sulphate tablets are similar to those of original drug, but generic drug has obvious economy advantage.