{"id":12688,"date":"2015-06-11T09:44:01","date_gmt":"2015-06-11T08:44:01","guid":{"rendered":"https:\/\/www.heartgenetics.com\/for-specialists\/pharmacogenomics\/clopidogrel-pharmacogenetics\/"},"modified":"2023-04-05T15:35:26","modified_gmt":"2023-04-05T14:35:26","slug":"p-clopidogrel-pharmacogenetics","status":"publish","type":"page","link":"https:\/\/www.heartgenetics.com\/pt\/pacientes\/terapeutica-personalizada\/p-clopidogrel-pharmacogenetics\/","title":{"rendered":"Clopidogrel PGx"},"content":{"rendered":"<h2 class=\"wp-block-heading\">Clopidogrel<\/h2><p>Clopidogrel \u00e9 um medicamento utilizado a n\u00edvel mundial como agente antiplaquet\u00e1rio no tratamento e preven\u00e7\u00e3o de eventos aterotromb\u00f3ticos. Sendo um pr\u00f3-f\u00e1rmaco, o clopidogrel necessita de bioactiva\u00e7\u00e3o hep\u00e1tica numa forma activa (Clo-AM) a fim de inibir a agrega\u00e7\u00e3o plaquet\u00e1ria.<\/p><p>Se n\u00e3o for devidamente metabolizado, o clopidogrel pode causar efeitos cardiovasculares adversos graves devido a uma dose n\u00e3o \u00f3ptima de drogas.<\/p><div class=\"wp-block-kobu-custom-blocks-responsive-spacer responsive-spacer size-large\"><\/div><h2 class=\"wp-block-heading\">Farmacogen\u00e9tica Clopidogrel<\/h2><p>O<strong> CYP2C19 <\/strong>\u00e9 uma enzima hep\u00e1tica importante para a metaboliza\u00e7\u00e3o de drogas e \u00e9 respons\u00e1vel pela ativa\u00e7\u00e3o metab\u00f3lica do clopidogrel. Considerando a farmacogen\u00e9tica do clopidogrel, sabe-se que as variantes gen\u00e9ticas do CYP2C19 prejudicam o metabolismo deste f\u00e1rmaco. Os polimorfismos de perda de fun\u00e7\u00e3o afetam a inibi\u00e7\u00e3o das plaquetas ao diminuir os n\u00edveis de <strong>Clop-Am<\/strong>, resultando num aumento do risco de recorr\u00eancia de grandes eventos cardiovasculares adversos.<\/p><div class=\"wp-block-kobu-custom-blocks-responsive-spacer responsive-spacer size-medium\"><\/div><h3 class=\"wp-block-heading\">Benef\u00edcios dos testes gen\u00e9ticos<\/h3><p>Ao avaliar as variantes gen\u00e9ticas do <strong>CYP2C19<\/strong> \u00e9 poss\u00edvel:<\/p><ul class=\"wp-block-list\"><li>avaliar a resposta do paciente ao clopidogrel<\/li><li>prescrever uma dose adequada<\/li><li>definir terapia alternativa antiplaquet\u00e1ria<\/li><li>evitar efeitos cardiovasculares adversos<\/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 3 variantes gen\u00e9ticas do gene <strong>CYP2C19<\/strong> (9 hapl\u00f3tipos ) que est\u00e3o associadas \u00e0 farmacocin\u00e9tica do clopidogrel. Os polimorfismos podem ou aumentar (alelos de ganho de fun\u00e7\u00e3o) ou diminuir (alelos de perda de fun\u00e7\u00e3o) a atividade catal\u00edtica da enzima <strong>CYP2C19<\/strong> resultando em fen\u00f3tipos que afetam o metabolismo do clopidogrel e a consequente inibi\u00e7\u00e3o das plaquetas..<\/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-69e678079104c\" 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-69e678079104c\" id=\"accordion-trigger0-accordion-group-69e678079104c\" type=\"button\">\n                            <span class=\"accordion-title\">CYP2C19<\/span>\n                        <\/button>\n                    <\/dt>\n                    <dd id=\"accordion-content0-accordion-group-69e678079104c\" aria-labelledby=\"accordion-trigger0-accordion-group-69e678079104c\" class=\"accordion-panel\" style=\"display: block;\">\n                        <div class=\"accordion-content\">\n                            <p>Citocromo P450, Fam\u00edlia 2, Subfam\u00edlia C, Polip\u00e9ptido 19, \u00e9 um membro da superfam\u00edlia citocromo P450 com uma a\u00e7\u00e3o significativa no metabolismo do clopidogrel<\/p>\n                        <\/div>\n                    <\/dd>\n                    <\/dl>\n    <\/div><div class=\"wp-block-kobu-custom-blocks-responsive-spacer responsive-spacer size-large\"><\/div><h2 class=\"wp-block-heading\">Diretrizes internacionais E ANOTA\u00c7\u00d5ES DE R\u00d3TULOS DE f\u00e1rmacos<\/h2><p>Os testes gen\u00e9ticos s\u00e3o recomendados por v\u00e1rias organiza\u00e7\u00f5es internacionais de renome, tais como a Food and Drug Administration (FDA) e o Clinical Pharmacogenetics Implementation Consortium (CPIC)<\/p><p>A FDA adverte que os pacientes que n\u00e3o metabolizam eficazmente o clopidogrel est\u00e3o em risco cardiovascular acrescido e, portanto, indicam que, quando poss\u00edvel, a presen\u00e7a de alelos CYP2C19 n\u00e3o funcionais deve ser testada. Nestes casos, recomenda que os profissionais de sa\u00fade considerem a utiliza\u00e7\u00e3o de outros medicamentos antiplaquet\u00e1rios.<\/p><p>O Clinical Pharmacogenetics Implementation Consortium (CPIC), que desenvolve diretrizes de medicamentos gen\u00e9ticos revistas por pares com base em novos desenvolvimentos no campo, estabeleceu v\u00e1rias recomenda\u00e7\u00f5es sobre terapia alternativa antiplaquet\u00e1ria baseada no gen\u00f3tipo <strong>CYP2C19<\/strong>.<\/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 sdias \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] Angiolillo et al., Journal of the American College of Cardiology 49, 1505\u20131516 (2007)<br>[2] Holmes et al., JAMA 306, 2704\u20132714 (2011)<br>[3] Mega et al., The New England Journal of Medicine 360, 354\u2013362 (2009)<br>[4] Scott et al., Clinical Pharmacology and Therapeutics 94, 317\u2013323 (2013)<\/p><\/div>","protected":false},"excerpt":{"rendered":"<p>Clopidogrel Clopidogrel \u00e9 um medicamento utilizado a n\u00edvel mundial como agente antiplaquet\u00e1rio no tratamento e preven\u00e7\u00e3o de eventos aterotromb\u00f3ticos. Sendo um pr\u00f3-f\u00e1rmaco, o clopidogrel necessita [&hellip;]<\/p>\n","protected":false},"author":5,"featured_media":12168,"parent":15287,"menu_order":170,"comment_status":"closed","ping_status":"closed","template":"templates\/mygenes.php","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-12688","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\/12688","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=12688"}],"version-history":[{"count":13,"href":"https:\/\/www.heartgenetics.com\/pt\/wp-json\/wp\/v2\/pages\/12688\/revisions"}],"predecessor-version":[{"id":15428,"href":"https:\/\/www.heartgenetics.com\/pt\/wp-json\/wp\/v2\/pages\/12688\/revisions\/15428"}],"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\/12168"}],"wp:attachment":[{"href":"https:\/\/www.heartgenetics.com\/pt\/wp-json\/wp\/v2\/media?parent=12688"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}