{"id":12683,"date":"2015-06-10T13:55:14","date_gmt":"2015-06-10T12:55:14","guid":{"rendered":"https:\/\/www.heartgenetics.com\/for-specialists\/pharmacogenomics\/warfarin-pharmacogenetics\/"},"modified":"2023-04-05T15:35:43","modified_gmt":"2023-04-05T14:35:43","slug":"p-warfarin-pharmacogenetics","status":"publish","type":"page","link":"https:\/\/www.heartgenetics.com\/pt\/pacientes\/terapeutica-personalizada\/p-warfarin-pharmacogenetics\/","title":{"rendered":"Varfarina PGx"},"content":{"rendered":"<h2 class=\"wp-block-heading\">varfarina<\/h2><p>A varfarina \u00e9 um dos anticoagulantes orais mais utilizados e \u00e9 o agente mais eficaz na preven\u00e7\u00e3o de doen\u00e7as tromb\u00f3ticas. A dosagem de drogas deve ser cuidadosamente controlada a fim de se obterem os m\u00e1ximos benef\u00edcios terap\u00eauticos.<\/p><p>A efic\u00e1cia da varfarina est\u00e1 altamente dependente da obten\u00e7\u00e3o e manuten\u00e7\u00e3o de uma janela terap\u00eautica estreita. A sua utiliza\u00e7\u00e3o est\u00e1 associada a um risco acrescido de forma\u00e7\u00e3o de co\u00e1gulos sangu\u00edneos quando o tratamento \u00e9 subterap\u00eautico (TIN inferior a 2) ou hemorr\u00e1gico quando supraterap\u00eautico (TIN de 4 ou mais). O estudo farmacogen\u00e9tico pode ser utilizado para determinar a dose inicial ideal de warfarina.<\/p><div class=\"wp-block-kobu-custom-blocks-responsive-spacer responsive-spacer size-medium\"><\/div><div class=\"multiple-row-columns aligndefault has-3-columns has-style-simplecenter\">\n\t\t<div class=\"multiple-row-columns-wrapper\" data-columns=\"3\">\n\t\t\t\t\t\t\t<div class=\"column\">\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t<noscript class=\"loading-lazy\">\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"414\" height=\"414\" src=\"https:\/\/www.heartgenetics.com\/files\/uploads\/2022\/05\/HG_icon_blue_circle-15.png\" class=\"attachment-medium_large size-medium_large\" alt=\"\" srcset=\"https:\/\/www.heartgenetics.com\/files\/uploads\/2022\/05\/HG_icon_blue_circle-15.png 414w, https:\/\/www.heartgenetics.com\/files\/uploads\/2022\/05\/HG_icon_blue_circle-15-300x300.png 300w, https:\/\/www.heartgenetics.com\/files\/uploads\/2022\/05\/HG_icon_blue_circle-15-150x150.png 150w, https:\/\/www.heartgenetics.com\/files\/uploads\/2022\/05\/HG_icon_blue_circle-15-100x100.png 100w\" sizes=\"auto, (max-width: 414px) 100vw, 414px\" \/>\t\t\t\t\t\t<\/noscript>\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"description\"><p>\u00c9 o anticoagulante oral mais amplamente utilizado.<\/p>\n<\/div>\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"column\">\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t<noscript class=\"loading-lazy\">\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"415\" height=\"415\" src=\"https:\/\/www.heartgenetics.com\/files\/uploads\/2015\/01\/HG_icon_blue_circle-13.png\" class=\"attachment-medium_large size-medium_large\" alt=\"\" srcset=\"https:\/\/www.heartgenetics.com\/files\/uploads\/2015\/01\/HG_icon_blue_circle-13.png 415w, https:\/\/www.heartgenetics.com\/files\/uploads\/2015\/01\/HG_icon_blue_circle-13-100x100.png 100w, https:\/\/www.heartgenetics.com\/files\/uploads\/2015\/01\/HG_icon_blue_circle-13-150x150.png 150w, https:\/\/www.heartgenetics.com\/files\/uploads\/2015\/01\/HG_icon_blue_circle-13-300x300.png 300w\" sizes=\"auto, (max-width: 415px) 100vw, 415px\" \/>\t\t\t\t\t\t<\/noscript>\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"description\"><p>Est\u00e1 entre os agentes mais eficazes na preven\u00e7\u00e3o de doen\u00e7as tromb\u00f3ticas.<\/p>\n<\/div>\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"column\">\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t<noscript class=\"loading-lazy\">\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"414\" height=\"415\" src=\"https:\/\/www.heartgenetics.com\/files\/uploads\/2015\/01\/HG_icon_blue_circle-05.png\" class=\"attachment-medium_large size-medium_large\" alt=\"\" srcset=\"https:\/\/www.heartgenetics.com\/files\/uploads\/2015\/01\/HG_icon_blue_circle-05.png 414w, https:\/\/www.heartgenetics.com\/files\/uploads\/2015\/01\/HG_icon_blue_circle-05-100x100.png 100w, https:\/\/www.heartgenetics.com\/files\/uploads\/2015\/01\/HG_icon_blue_circle-05-150x150.png 150w, https:\/\/www.heartgenetics.com\/files\/uploads\/2015\/01\/HG_icon_blue_circle-05-300x300.png 300w\" sizes=\"auto, (max-width: 414px) 100vw, 414px\" \/>\t\t\t\t\t\t<\/noscript>\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"description\"><p>A dosagem deve ser cuidadosamente controlada a fim de obter o m\u00e1ximo de benef\u00edcios terap\u00eauticos.<\/p>\n<\/div>\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t<\/div><div class=\"wp-block-kobu-custom-blocks-responsive-spacer responsive-spacer size-large\"><\/div><h2 class=\"wp-block-heading\">Farmacogen\u00e9tica VARFARINA<\/h2><p>O gen\u00f3tipo de um indiv\u00edduo \u00e9 um determinante importante da resposta aos medicamentos e da variabilidade das doses. Na farmacogen\u00e9tica, as variantes gen\u00e9ticas de <strong>CYP2C9<\/strong> est\u00e3o associadas a uma reduzida atividade enzim\u00e1tica e a menores taxas de depura\u00e7\u00e3o de varfarina. As variantes gen\u00e9ticas do gene <strong>VKORC1 <\/strong>contribuem para a resist\u00eancia \u00e0 varfarina e causam uma diferen\u00e7a significativa no \u00edndice de sensibilidade \u00e0 varfarina.<\/p><div class=\"wp-block-kobu-custom-blocks-responsive-spacer responsive-spacer size-medium\"><\/div><h3 class=\"wp-block-heading\">BENEF\u00cdCIOS DOS TESTES GEN\u00c9TICOS<\/h3><p>Ao avaliar as variantes gen\u00e9ticas <strong>CYP2C9<\/strong> e <strong>VKORC1<\/strong>, \u00e9 poss\u00edvel<\/p><ul class=\"wp-block-list\"><li>avaliar a resposta do paciente \u00e0 varfarina<\/li><li>prescrever uma dose adequada<\/li><li>evitar os efeitos secund\u00e1rios adversos da dosagem n\u00e3o \u00f3ptima de varfarina<\/li><\/ul><div class=\"wp-block-kobu-custom-blocks-responsive-spacer responsive-spacer size-large\"><\/div><h2 class=\"wp-block-heading\">Painel Gen\u00e9tico<\/h2><p>O teste gen\u00e9tico avalia variantes gen\u00e9ticas nos genes CYP2C9 e VKORC1. O teste gen\u00e9tico avalia os 18 hapl\u00f3tipos poss\u00edveis associados ao metabolismo da varfarina. Por exemplo, os alelos *2 e *3 do gene CYP2C9 s\u00e3o respons\u00e1veis por uma redu\u00e7\u00e3o do metabolismo da varfarina; a variante G-1639A no gene VKORC1 \u00e9 um determinante importante da variabilidade da sensibilidade \u00e0 varfarina.<\/p><p>As variantes desses genes foram aprovadas pela FDA e tamb\u00e9m pelo International Warfarin Pharmacogenomics Consortium para orientar a terapia.<\/p><div class=\"wp-block-kobu-custom-blocks-responsive-spacer responsive-spacer size-medium\"><\/div><div class=\"accordion \">\n            <dl id=\"accordion-group-accordion-group-69e662ab1f240\" role=\"presentation\">\n                                <dt aria-level=\"3\" class=\" open\" data-index=\"0\">\n                        <button aria-expanded=\"true\" class=\"accordion-trigger\" aria-controls=\"accordion-content0-accordion-group-69e662ab1f240\" id=\"accordion-trigger0-accordion-group-69e662ab1f240\" type=\"button\">\n                            <span class=\"accordion-title\">CYP2C9<\/span>\n                        <\/button>\n                    <\/dt>\n                    <dd id=\"accordion-content0-accordion-group-69e662ab1f240\" aria-labelledby=\"accordion-trigger0-accordion-group-69e662ab1f240\" class=\"accordion-panel\" style=\"display: block;\">\n                        <div class=\"accordion-content\">\n                            <p>Citocromo P450, Fam\u00edlia, Subfam\u00edlia C, Polip\u00e9ptido 9, \u00e9 um membro da superfam\u00edlia citocromo P450 com uma ac\u00e7\u00e3o significativa no metabolismo da varfarina<\/p>\n                        <\/div>\n                    <\/dd>\n                                <dt aria-level=\"3\" class=\"\" data-index=\"1\">\n                        <button aria-expanded=\"false\" class=\"accordion-trigger\" aria-controls=\"accordion-content1-accordion-group-69e662ab1f240\" id=\"accordion-trigger1-accordion-group-69e662ab1f240\" type=\"button\">\n                            <span class=\"accordion-title\">VKORC1<\/span>\n                        <\/button>\n                    <\/dt>\n                    <dd id=\"accordion-content1-accordion-group-69e662ab1f240\" aria-labelledby=\"accordion-trigger1-accordion-group-69e662ab1f240\" class=\"accordion-panel\" >\n                        <div class=\"accordion-content\">\n                            <p>O Complexo de Vitamina K Ep\u00f3xida Redutase, Subunidade 1, codifica a Vitamina K-ep\u00f3xido redutase, que catalisa a convers\u00e3o da vitamina K-ep\u00f3xido em vitamina K<\/p>\n                        <\/div>\n                    <\/dd>\n                    <\/dl>\n    <\/div><div class=\"wp-block-kobu-custom-blocks-responsive-spacer responsive-spacer size-large\"><\/div><h3 class=\"wp-block-heading\">WARFARINA E TROMBOFILIA HEREDIT\u00c1RIA<\/h3><p>Warfarina \u00e9 o anticoagulante mais eficaz para prevenir a trombose. \u00c9 utilizado no contexto cl\u00ednico da trombofilia heredit\u00e1ria.<\/p><div class=\"wp-block-buttons is-layout-flex wp-block-buttons-is-layout-flex\"><div class=\"wp-block-button\"><a class=\"wp-block-button__link\" href=\"https:\/\/www.heartgenetics.com\/pt\/especialistas\/genetica-cardiovascular\/trombogene\/\">Saiba mais sobre o Trombogene<\/a><\/div><\/div><div class=\"wp-block-kobu-custom-blocks-responsive-spacer responsive-spacer size-large\"><\/div><h2 class=\"wp-block-heading\">DIRECTRIZES INTERNACIONAIS E ANOTA\u00c7\u00d5ES DE R\u00d3TULOS DE f\u00e1rmacos<\/h2><p>O r\u00f3tulo do medicamento warfarin aprovado pela FDA fornece uma tabela de dosagem baseada nos gen\u00f3tipos CYP2C9 e VKORC1.<\/p><p>Tamb\u00e9m o Clinical Pharmacogenetics Implementation Consortium (CPIC) do National Institutes of Health Pharmacogenomics Research Network (CPIC) desenvolve orienta\u00e7\u00f5es sobre medicamentos gen\u00e9ticos revistas por pares que s\u00e3o publicadas e actualizadas periodicamente com base em novos desenvolvimentos na \u00e1rea [2,9].<\/p><div class=\"wp-block-kobu-custom-blocks-responsive-spacer responsive-spacer size-large\"><\/div><div class=\"wp-block-kobu-custom-blocks-section-wrapper alignfull kobu-section has-background has-quinary-background-color\"><div class=\"wp-block-kobu-custom-blocks-responsive-spacer responsive-spacer size-large\"><\/div>\n\n<div class=\"wp-block-columns two-columns-icon-left is-layout-flex wp-container-core-columns-is-layout-1 wp-block-columns-is-layout-flex\"><div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\"><noscript class=\"loading-lazy\"><figure class=\"wp-block-image size-full is-resized\"><a href=\"https:\/\/www.heartgenetics.com\/files\/uploads\/2022\/05\/heartgenetics-turnaroundtime-icon.png\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.heartgenetics.com\/files\/uploads\/2022\/05\/heartgenetics-turnaroundtime-icon.png\" alt=\"10 days Turn around time\" class=\"wp-image-12512\" width=\"108\" height=\"108\" srcset=\"https:\/\/www.heartgenetics.com\/files\/uploads\/2022\/05\/heartgenetics-turnaroundtime-icon.png 300w, https:\/\/www.heartgenetics.com\/files\/uploads\/2022\/05\/heartgenetics-turnaroundtime-icon-150x150.png 150w, https:\/\/www.heartgenetics.com\/files\/uploads\/2022\/05\/heartgenetics-turnaroundtime-icon-100x100.png 100w\" sizes=\"auto, (max-width: 108px) 100vw, 108px\" \/><\/a><\/figure><\/noscript><\/div>\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\"><h2 class=\"has-large-font-size wp-block-heading\">TEMPO DE RETORNO<\/h2>\n\n<p>10 dias \u00fateis<\/p>\n\n<div style=\"height:20px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n<div class=\"wp-block-buttons is-layout-flex wp-block-buttons-is-layout-flex\"><div class=\"wp-block-button\"><a class=\"wp-block-button__link\" href=\"https:\/\/www.heartgenetics.com\/pt\/contacts\/\">Clique aqui para contactar o departamento de vendas<\/a><\/div><\/div><\/div><\/div>\n\n<div class=\"wp-block-kobu-custom-blocks-responsive-spacer responsive-spacer size-large\"><\/div><\/div><div class=\"wp-block-kobu-custom-blocks-responsive-spacer responsive-spacer size-large\"><\/div><h2 class=\"wp-block-heading\">Estudos cient\u00edficos<\/h2><div class=\"wp-block-group is-layout-flow wp-block-group-is-layout-flow\">[1] Johnson et al., Clinical Pharmacology and Therapeutics 90, 625\u2013629 (2011)<br>[2] Kamali et al., Annual Review of Medicine 61, 63\u201375 (2010)<br>[3] Limdi et al., Blood 115, 3827\u20133834 (2010)<br>[4] Moyer et al., Mayo Clinic Proceedings 84, 1079\u20131094 (2009)<br>[5] Schwarz et al., The New England Journal of Medicine 358, 999\u20131008 (2008)<\/p><\/div>","protected":false},"excerpt":{"rendered":"<p>varfarina A varfarina \u00e9 um dos anticoagulantes orais mais utilizados e \u00e9 o agente mais eficaz na preven\u00e7\u00e3o de doen\u00e7as tromb\u00f3ticas. A dosagem de drogas [&hellip;]<\/p>\n","protected":false},"author":5,"featured_media":12172,"parent":15287,"menu_order":163,"comment_status":"closed","ping_status":"closed","template":"templates\/mygenes.php","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-12683","page","type-page","status-publish","has-post-thumbnail","hentry"],"acf":[],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.heartgenetics.com\/pt\/wp-json\/wp\/v2\/pages\/12683","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.heartgenetics.com\/pt\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.heartgenetics.com\/pt\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.heartgenetics.com\/pt\/wp-json\/wp\/v2\/users\/5"}],"replies":[{"embeddable":true,"href":"https:\/\/www.heartgenetics.com\/pt\/wp-json\/wp\/v2\/comments?post=12683"}],"version-history":[{"count":18,"href":"https:\/\/www.heartgenetics.com\/pt\/wp-json\/wp\/v2\/pages\/12683\/revisions"}],"predecessor-version":[{"id":15430,"href":"https:\/\/www.heartgenetics.com\/pt\/wp-json\/wp\/v2\/pages\/12683\/revisions\/15430"}],"up":[{"embeddable":true,"href":"https:\/\/www.heartgenetics.com\/pt\/wp-json\/wp\/v2\/pages\/15287"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.heartgenetics.com\/pt\/wp-json\/wp\/v2\/media\/12172"}],"wp:attachment":[{"href":"https:\/\/www.heartgenetics.com\/pt\/wp-json\/wp\/v2\/media?parent=12683"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}