Detection and prediction of clopidogrel treatment failures using longitudinal structured electronic health records

We propose machine learning algorithms to automatically detect and predict clopidogrel treatment failure using longitudinal structured electronic health records (EHR). By drawing analogies between natural language and structured EHR, we introduce various machine learning algorithms used in natural language processing (NLP) applications to build models for treatment failure detection and prediction. In this regard, we generated a cohort of patients with clopidogrel prescriptions from UK Biobank and annotated if the patients had treatment failure events within one year of the first clopidogrel prescription; out of 502,527 patients, 1,824 patients were identified as treatment failure cases, and 6,859 patients were considered as control cases. From the dataset, we gathered diagnoses, prescriptions, and procedure records together per patient and organized them into visits with the same date to build models. The models were built for two different tasks, i.e., detection and prediction, and the experimental results showed that time series models outperform bag-of-words approaches in both tasks. In particular, a Transformer-based model, namely BERT, could reach 0.928 AUC in detection tasks and 0.729 AUC in prediction tasks. BERT also showed competence over other time series models when there is not enough training data, because it leverages the pre-training procedure using large unlabeled data.