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The Keeper also unlocks Rib of Greed, Karma and Deep Pockets, which are good trinkets/items. Greeds Gullet and Crooked Penny are excellent (if they work).
It's still a close call between him and Cain. Evil Eye, Sack of Sacks and Silver Dollar are okay, but i have to go with Cain here, just for Abel clogging up the Golden Chest pool alone. His other unlocks are mostly useless as well, especially now, that Bomb/Coin bag can show up in Golden Chests since AB+. Sure, an early Bomb Bag is pretty neat, but wouldn't you rather have Steven or Guppy's Head instead?
The best unlocks are Lilith. Incubus/succubus are not only amazingly good, they can break so many challenges wide open its not even funny. Serpents kiss can save runs.
The lost's unlocks are pretty good too, but they can be so rare to find.
Godhead is neat but I really don't get why people say it's an instant win. The damaging aura never seemed as rewarding to me as a good damage boost.
Silver Dollar is more than ok. Since Mama Mega can open the entrance to blue womb, this trinket can make restock exploitation runs much easier.
No the worst unlocks are definitely Keepers. Especially considering how hard it is to unlock anything with him. And Eve has athame and sacrifial dagger as unlocks.
At least combined with homing tears, it really isn't. You'll need to run into enemies on purpose tho and count on killing them with it, so you get the black hearts. Using it with the expectation to be a damage bonus in case you get hit, is the wrong approach. Also I haven't had a chance yet to try the dull razor on it, but I think it should activate it.
Keeping red hp stops polaroid invincibility. And rips really cool items like empty vessel. Plus maw of the void is a thing.
You don't need to get red heart damage for athame to activate. ANY damage to you and dull razor prolly (I dunno cause I didn't unlock that yet) will activate it. If there are enough weak enemies in the room, you can often get 2 black hearts out of it.
A problem is starting at womb you take a full heart of damage. Black hearts destroy weak enemies when they blow up and asthame rewards black hearts.
I never said athame is useless item, just that its rubbish. It has many things working against it.