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High-frequency rTMS was no better than sham rTMS and conventional rehabilitation for improving aphasia. The rTMS had better effects in naming, comprehension and aphasia quotient at 20 sessions. Eleven studies reported rTMS was safe for aphasia patients after stroke. The quality of evidence for all outcomes was low or very low, and publication bias may exist. rTMS may be relatively effective and safe for aphasia patients after stroke. However, these findings should be treated with caution due to high heterogeneity and potential biases. rTMS