{"id":15297,"date":"2023-04-04T14:52:44","date_gmt":"2023-04-04T13:52:44","guid":{"rendered":"https:\/\/www.heartgenetics.com\/?page_id=15297"},"modified":"2024-10-07T16:48:18","modified_gmt":"2024-10-07T15:48:18","slug":"s-warfarin-pharmacogenetics","status":"publish","type":"page","link":"https:\/\/www.heartgenetics.com\/pt\/especialistas\/farmacogenomica\/s-warfarin-pharmacogenetics\/","title":{"rendered":"Varfarina PGx"},"content":{"rendered":"<h2 class=\"wp-block-heading\">WARFARIN<\/h2><p>Warfarin is one of the most widely used oral anticoagulant drugs and it is the most effective agent in preventing thrombotic disorders. Drug dosage should be carefully monitored in order to obtain maximum therapeutic benefits.<\/p><p>Warfarin efficacy is highly dependent on achieving and maintaining a narrow therapeutic window. Its use is associated with an increased risk of blood clot formation when treatment is subtherapeutic (INR of less than 2) or bleeding when supratherapeutic (INR of 4 or more). The pharmacogenetics study can be used to determine the optimal starting dose of warfarin.<\/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>Is the most widely used oral anticoagulant.<\/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>Is among the most effective agents in preventing thrombotic disorders.<\/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>Dosage should be carefully monitored in order to obtain maximum therapeutic benefits.<\/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\">Warfarin Pharmacogenetics<\/h2><p>The genotype of an individual is a major determinant to drug response and dose variability. In pharmacogenetics, genetic variants of <strong>CYP2C9<\/strong> are associated with reduced enzyme activity and lower clearance rates of warfarin. Genetic variants of <strong>VKORC1<\/strong> gene contribute to warfarin resistance and cause a significant difference in warfarin sensitivity index.<\/p><div class=\"wp-block-kobu-custom-blocks-responsive-spacer responsive-spacer size-medium\"><\/div><h3 class=\"wp-block-heading\">Benefits of genetic testing<\/h3><p>By evaluating <strong>CYP2C9<\/strong> and <strong>VKORC1<\/strong> genetic variants, it is possible to:<\/p><ul class=\"wp-block-list\"><li>evaluate the patient response to warfarin<\/li><li>prescribe an adequate dose<\/li><li>avoid the adverse side-effects of non-optimal warfarin dosage<\/li><\/ul><div class=\"wp-block-kobu-custom-blocks-responsive-spacer responsive-spacer size-large\"><\/div><h2 class=\"wp-block-heading\">Genetic Panel<\/h2><p>The genetic test evaluates genetic variants in CYP2C9 and VKORC1 genes. The genetic test evaluates all 18 possible haplotypes associated with warfarin metabolism. For example, the *2 and *3 alleles of CYP2C9 gene are responsible for a reduction in warfarin metabolism; the variant G-1639A in VKORC1 gene is a major determinant of variability in sensitivity to warfarin.<\/p><p>The variants from those genes have been approved by the FDA and also by the International Warfarin Pharmacogenomics Consortium to guide therapy.<\/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-69e6541fb3dfc\" 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-69e6541fb3dfc\" id=\"accordion-trigger0-accordion-group-69e6541fb3dfc\" type=\"button\">\n                            <span class=\"accordion-title\">CYP2C9<\/span>\n                        <\/button>\n                    <\/dt>\n                    <dd id=\"accordion-content0-accordion-group-69e6541fb3dfc\" aria-labelledby=\"accordion-trigger0-accordion-group-69e6541fb3dfc\" class=\"accordion-panel\" style=\"display: block;\">\n                        <div class=\"accordion-content\">\n                            <p>u003cspan style=u0022font-weight: 400;u0022u003eCytochrome P450, Family, Subfamily C, Polypeptide 9, is a member of the cytochrome P450 superfamily with a significant action in warfarin metabolismu003c\/spanu003e<\/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-69e6541fb3dfc\" id=\"accordion-trigger1-accordion-group-69e6541fb3dfc\" type=\"button\">\n                            <span class=\"accordion-title\">VKORC1<\/span>\n                        <\/button>\n                    <\/dt>\n                    <dd id=\"accordion-content1-accordion-group-69e6541fb3dfc\" aria-labelledby=\"accordion-trigger1-accordion-group-69e6541fb3dfc\" class=\"accordion-panel\" >\n                        <div class=\"accordion-content\">\n                            <p>u003cspan style=u0022font-weight: 400;u0022u003eVitamine K Epoxide Reductase Complex, Subunit 1, encodes the Vitamin K-epoxide reductase, which catalyzes the conversion of vitamin K-epoxide into vitamin Ku003c\/spanu003e<\/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\">Warfarin and Hereditary Thrombophilia<\/h3><p>Warfarin is the most effective anticoagulant to prevent thrombosis. It is used in the clinical context of hereditary thrombophilia.<\/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\/for-specialists\/cardiovascular-genetics\/trombogene\/\">Learn more about Trombogene<\/a><\/div><\/div><div class=\"wp-block-kobu-custom-blocks-responsive-spacer responsive-spacer size-large\"><\/div><h2 class=\"wp-block-heading\">International Guidelines AND DRUG LABEL ANNOTATIONS<\/h2><p>The FDA-approved warfarin drug label provides a dosing table based on CYP2C9 and VKORC1 genotypes.<\/p><p>Also, the Clinical Pharmacogenetics Implementation Consortium (CPIC) of the National Institutes of Health Pharmacogenomics Research Network develops peer-reviewed gene-drug guidelines that are published and updated periodically based on new developments in the field [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\">Turnaround time<\/h2>\n\n<p>10 working days<\/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\/contacts\/\">Click here to contact sales<\/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\">Scientific Studies<\/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>WARFARIN Warfarin is one of the most widely used oral anticoagulant drugs and it is the most effective agent in preventing thrombotic disorders. Drug dosage [&hellip;]<\/p>\n","protected":false},"author":254,"featured_media":12172,"parent":12671,"menu_order":163,"comment_status":"closed","ping_status":"closed","template":"templates\/mygenes.php","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-15297","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\/15297","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\/254"}],"replies":[{"embeddable":true,"href":"https:\/\/www.heartgenetics.com\/pt\/wp-json\/wp\/v2\/comments?post=15297"}],"version-history":[{"count":7,"href":"https:\/\/www.heartgenetics.com\/pt\/wp-json\/wp\/v2\/pages\/15297\/revisions"}],"predecessor-version":[{"id":15749,"href":"https:\/\/www.heartgenetics.com\/pt\/wp-json\/wp\/v2\/pages\/15297\/revisions\/15749"}],"up":[{"embeddable":true,"href":"https:\/\/www.heartgenetics.com\/pt\/wp-json\/wp\/v2\/pages\/12671"}],"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=15297"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}